Treatment of ungual and subungual diseases

ABSTRACT

The treatment of ungual and subungual diseases is disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is a continuation-in-part and claims the benefitof priority under 35 U.S.C. §120 of: U.S. patent application Ser. No.10/128,208, filed Apr. 23, 2002, and entitled “Therapeutic TreatmentsUsing the Direct Application of Noble Metal Compositions;” U.S. patentapplication Ser. No. 10/131,509, filed Apr. 23, 2002, and entitled“Treatment of Mucosal Membranes;” U.S. patent application Ser. No.10/131,511, filed Apr. 23, 2002, and entitled “Treatment of InflammatorySkin Conditions;” U.S. patent application Ser. No. 10/131,568, filedApr. 23, 2002, and entitled “Method of Induction of Apoptosis andInhibition of Matrix Metalloproteinases Using Antimicrobial Metals;” andU.S. patent application Ser. No. 10/159,587, filed May 30, 2002,entitled “Method of Induction of Apoptosis and Inhibition of MatrixMetalloproteinases Using Antimicrobial Metals,” U.S. patent applicationSer. No. 10/277,673, filed Oct. 22, 2002, and entitled “Solutions andAerosols Of Metal-Containing Compounds;” U.S. patent application Ser.No. 10/277,356, filed Oct. 22, 2002, and entitled “Compositions OfMetal-Containing Compounds;” U.S. patent application Ser. No.10/277,298, filed Oct. 22, 2002, and entitled “Dry Powders ofMetal-Containing Compounds;” U.S. patent application Ser. No.10/277,362, filed Oct. 22, 2002, and entitled “Methods of Treating Skinand Integument Conditions;” U.S. patent application Ser. No. 10/277,358,filed Oct. 22, 2002, and entitled “Methods Of Treating Conditions With AMetal-Containing Material;” U.S. patent application Ser. No. 10/277,320,filed Oct. 22, 2002, and entitled “Methods Of Inducing Apoptosis AndModulating Metalloproteinases;” U.S. patent application Ser. No.10/690,774, filed Oct. 22, 2003, and entitled “Metal-ContainingMaterials;” U.S. patent application Ser. No. 10/690,724, filed Oct. 22,2003, and entitled “Methods of Treating Conditions UsingMetal-Containing Materials;” and U.S. patent application Ser. No.10/690,715, filed Oct. 22, 2003, and entitled “Compositions and MethodsOf Metal-Containing Materials.” Each of these applications isincorporated by reference.

TECHNICAL FIELD

[0002] The invention relates to the treatment of ungual and subungualdiseases.

BACKGROUND

[0003] It is generally desirable to treat a subject (e.g., a human) thathas an undesirable condition. Many different compositions have beendeveloped to treat undesirable conditions. For example, certain forms ofsilver have been reported to be effective in treating some undesirableskin conditions.

SUMMARY

[0004] The invention relates to the treatment of ungual and subungualdiseases.

[0005] In one aspect, the invention features a method for the treatmentor prophylaxis of an ungual or subungual disease of a subject. Themethod includes using a needleless injector to deliver a compound to anarea of the subject associated with the disease, the compound beingeffective in the treatment of the disease.

[0006] In another aspect, the invention features a method for thetreatment or prophylaxis of an ungual or subungual disease of a subject.The method includes using iontophoresis to deliver a compound to an areaof the subject associated with the disease, the compound being effectivein the treatment of the disease.

[0007] Embodiments can include one or more of the following aspects.

[0008] The compound can be, for example, a metal-containing material.

[0009] The compound can be, for example, an anti-fungal compound.

[0010] The compound can be, for example, selected from griseofulvin,terbinafine, citopirox, itraconazole, ketoconazole and combinationsthereof.

[0011] The disease can be, for example, selected from onychomycosis,tinea unguim infection, psoriasis of the unguis, eczema of the unguis,lichen planus of the unguis, viral warts of the unguis and combinationsthereof.

[0012] The disease can be a subungual disease.

[0013] The disease can be an ungual disease.

[0014] The area of the subject can be an unguis. As an example, thesubject can be a human, and the unguis can be a toe nail. As anotherexample, the subject can be a human, and the unguis can be a fingernail.

[0015] The area of the subject can be tissue (e.g., skin) adjacent anunguis of the subject.

[0016] The needleless injector and/or iontophoresis can deliver thecompound into an unguis of the subject.

[0017] The needleless injector and/or iontophoresis can deliver thecompound through the unguis of the subject.

[0018] The needleless injector and/or iontophoresis can deliver thecompound into tissue (e.g., skin) adjacent an unguis of the subject.

[0019] The needleless injector and/or iontophoresis can deliver thecompound through tissue (e.g., skin) adjacent the unguis.

[0020] The subject can be a human.

[0021] Other features and advantages of the methods will be apparentfrom the description and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

[0022]FIG. 1 is a schematic view of a deposition system;

[0023]FIG. 2 is a graph showing the efficacy of different forms ofsilver on erythema;

[0024]FIG. 3 is a graph showing the efficacy of different forms ofsilver on edema; FIG. 4 is a graph showing MMP activity of incisionfluids recovered from incisions dressed with materials;

[0025]FIG. 5 is a graph showing total protease activity of incisionfluids recovered from different dressings;

[0026]FIG. 6 is a graph showing the concentrations (ng/ml) of activeMMP-9 in fluid samples recovered from ulcers dressed with differentmaterials;

[0027]FIG. 7 is a graph showing the concentrations (ng/ml) of activeMMP-2 in fluid samples recovered from ulcers dressed with differentmaterials;

[0028]FIG. 8 is a graph showing the concentrations (pg/ml) of activeTNF-α in fluid samples recovered from ulcers dressed with differentmaterials; and

[0029]FIG. 9 is a graph showing the concentrations (pg/ml) of activeIL-1β in fluid samples recovered from ulcers dressed with differentmaterials.

DETAILED DESCRIPTION

[0030] The inventors have discovered that certain metal-containingmaterials (e.g., antimicrobial, atomically disordered, nanocrystallinesilver-containing materials) can be used to treat a subject with acondition by contacting an area of the subject having the condition withthe metal-containing material. As explained below, the metal-containingmaterial can be in any of a variety of forms when delivered to asubject, and the metal-containing material can be delivered to a subjectin a variety of ways. As also explained below, the metal-containingmaterial can be used to treat various subjects, conditions, andcondition locations.

[0031] Without wishing to be bound by theory, it is believed that thetherapeutic properties of the metal-containing materials may beexplained by one or more potential mechanisms. In one potentialmechanism (e.g., at relatively high pH), it is believed that themetal-containing material (e.g., antimicrobial, atomically disordered,nanocrystalline silver-containing materials) forms one or moremetastable, relatively high level metal hydroxide species (e.g., Ag(OH)₄³⁻, Ag(OH)₆ ³⁻) that either directly or indirectly (e.g., via theformation of one or more biological mediators) provide the observedtherapeutic properties. In another potential mechanism, it is believedthat the metal-containing material is capable of releasing clusters ofthe metal (e.g., clusters of Ag⁰, clusters of Ag⁺, clusters containingboth Ag⁺ and Ag⁰) that provide the observed therapeutic properties. In afurther potential mechanism, it is believed that the concentration ofsilver in a solution can be raised above the saturation concentration ofbare silver ions (e.g., to provide a relatively sustaining reservoir ofsilver as bare silver ions are consumed). It is believed that, as thebare silver ions are consumed, some of the other silver-containingspecies can decompose to create additional bare silver ions inaccordance with chemical equilibria. It is also believed that thepresence of silver in one or more forms other than bare silver ions mayraise the level for the effective silver concentration that isnonharmful (e.g., non-toxic) to the cells of a subject (e.g., a human).In an additional potential mechanism, it is believed that one or moreforms of silver complexes may be capable of penetrating cellularmembranes (e.g., by mimicking species that are normally transportedthrough the membranes), which may accelerate the permeation of silverinto the cells. In general, it is believed that the form of thesilver-containing species contained in an aqueous solution depends onthe solution pH and/or the concentrations of the varioussilver-containing species in the solid form of the silver-containingmaterial. It is believed that, in general, at low pH the dominantspecies is a bare silver ion, but that at higher pH, where thesolubility of bare silver ions is believed to be limited by thesolubility of silver hydroxide, other types of species includingcomplexed silver ions and/or silver-containing clusters becomeincreasingly stable provided that the concentration of bare silver ionsremains at the saturation concentration. It is also believed that thenature and relative population of the silver-containing species candepend on the rate at which the species can dissolve from the solidsilver-bearing material and the rate at which the species can react withone another in the solution. It is believed that combinations ofpotential mechanisms may result in the observed therapeutic effect ofthe metal-containing material.

[0032] In general, clusters refer to relatively small groups of atoms,ions or the like. For example, a cluster can contain at least two (e.g.,at least three, at least four, at least five, at least six, at leastseven, at least eight, at least nine, at least 10, at least 11, at least12, at least 13, at least 14, at least 15, at least 20, at least 30, atleast 40, at least 50, at least 60, at least 70, at least 80, at least90) atoms, ions or the like, and/or at most 1,000 (e.g., at most 900, atmost 800, at most 700, at most 600, at most 500, at most 400, at most300, at most 200, at most 100) atoms, ions or the like. Clusters aredescribed, for example, in R. P. Andres et al., “Research Opportunitieson Cluster and Cluster-Assembled Materials”, J. Mater. Res. Vol. 4, No3, 1989, p. 704. In certain embodiments, a cluster (e.g., a clustercontaining silver) can contain less than the 14 atoms and have a normalface centered cubic crystal lattice.

[0033] Materials

[0034] The metal-containing material can be an ionic material or anon-ionic material. The metal-containing material can be, for example,an atom, a molecule, or a cluster.

[0035] In general, the metal-containing material is a metal or an alloy.Examples of metal elements that can be contained in metal-containingmaterials include Group I A metal elements, Group II A metal elements,Group III A metal elements, Group IV A metal elements, Group V A metalelements, Group VI A metal elements, Group VII A metal elements, GroupVIII A metal elements, Group I B metal elements, Group II B metalelements, members of the lanthanide metal element series, and members ofthe actinide metal element series. In certain embodiments,metal-containing materials contain silver, gold, platinum, palladium,iridium, zinc, copper, tin, antimony, and/or bismuth. In someembodiments, a metal-containing material can include one or moretransition metal elements (e.g., scandium, titanium, vanadium, chromium,manganese, iron, cobalt, nickel, copper and/or zinc). As an example, ametal-containing material can contain silver and platinum.

[0036] Examples of silver-containing materials include colloidal silver,silver nitrate and silver sulfadiazine, silver carbonate, silveracetate, silver lactate, silver citrate, silver oxide, silver hydroxide,silver succinate, silver chlorate, silver stearate, silver sorbate,silver oleate, silver glutonate, silver adipate, silver myristate, andalkali silver thiosulphate (e.g., sodium silver thiosulphate, potassiumsilver thiosulphate).

[0037] In addition to one or more metal elements, a metal-containingmaterial can contain, for example, oxygen, nitrogen, carbon, boron,sulfur, phosphorus, silicon, a halogen (e.g., fluorine, chlorine,bromine, iodine) and/or hydrogen. Examples of such metal-containingmaterials include metal oxides, metal hydroxides, metal nitrides, metalcarbides, metal phosphides, metal silicates, metal borides, metalsulfides, metal halides (e.g., metal fluorides, metal chlorides, metalbromides, metal iodides), metal myristates, metal sorbates, metalstearates, metal oleates, metal glutonates, metal adipates, metalsilicates, metal phosphides, metal hydrides, metal nitrates, metalcarbonates, metal sulfadiazines, metal hydrides, metal acetates, metallactates, metal citrates, alkali metal thiosulphates (e.g., sodium metalthiosulphate, potassium metal thiosulphate). In certain embodiments, ametal-containing material contains at least about one atomic percent(e.g., at least about three atomic percent, at least about five atomicpercent, at least about 10 atomic percent, at least about 20 atomicpercent, at least about 30 atomic percent, at least about 40 atomicpercent, at least about 50 atomic percent) and/or at most about 90atomic percent (e.g., at most about 80 atomic percent, at most about 70atomic percent, at most about 60 atomic percent, at most about 50 atomicpercent, at most about 40 atomic percent, at most about 30 atomicpercent, at most about 20 atomic percent, at most about 15 atomicpercent, at most about 12 atomic percent, at most about 10 atomicpercent) of nonmetallic elements. For example, in some embodiments, asilver-containing material can contain oxygen in an amount from aboutfive atomic percent to about 20 atomic percent (e.g., from about fiveatomic percent to about 15 atomic percent, from about eight atomicpercent to about 12 atomic percent).

[0038] In certain embodiments, the metal-containing materials are anantimicrobial material, an anti-biofilm, an antibacterial material, ananti-inflammatory material, an antifungal material, an antiviralmaterial, an anti-autoimmune material, an anti-cancer material, apro-apoptosis material, an anti-proliferative material, an MMPmodulating material, an atomically disordered crystalline material,and/or a nanocrystalline material.

[0039] As used herein, an antimicrobial material herein refers to amaterial that has sufficient antimicrobial activity to have a beneficialtherapeutic effect. In certain embodiments, an antimicrobial materialhas a corrected zone of inhibition (“CZOI”) of at least about twomillimeters (e.g., at least about three millimeters, at least about fourmillimeters, at lest about five millimeters, at least about sixmillimeters, at least about seven millimeters, at least about eightmillimeters, at least about nine millimeters, at least about 10millimeters). The CZOI of a material is determined as follows. Thematerial is formed as a coating on a dressing (see discussion below).Basal medium Eagle (BME) with Earle's salts and L-glutamine is modifiedwith calf/serum (10%) and 1.5% agar prior to being dispensed (15 ml)into Petri dishes. The agar containing Petri dishes are allowed tosurface dry prior to being inoculated with a lawn of Staphylococcusaureus ATCC #25923. The inoculant is prepared from Bactrol Discs (Difco,M.) which are reconstituted as per the manufacturer's directions.Immediately after inoculation, the coatings to be tested are placed onthe surface of the agar. The dishes are incubated for 24 hours at 37° C.After this incubation period, the zone of inhibition (“ZOI”) is measuredand the CZOI is calculated as the ZOI minus the diameter of the testmaterial in contact with the agar. It is to be noted that, while thistest for antimicrobial properties is performed on materials that are inthe form of a coating on a substrate (e.g., in the form of a dressing),antimicrobial materials are not limited to materials that are coated ona substrate. Rather, a material in any form may be antimicrobial, but itis in the form of a coating on a substrate (e.g., in the form of adressing) when its antimicrobial properties are tested according to theprocedure described herein.

[0040] As referred to herein, an atomically disordered, crystallinematerial (e.g., an atomically disordered, nanocrystalline material)means a material that has more long range ordered, crystalline structure(a lesser degree of defects) than the material has in a fully amorphousstate, but that also has less long range, ordered crystalline structure(a higher degree of defects) than the material has in a bulk crystallinestate, such as in the form of a cast, wrought or plated material.Examples of defects include point defects, vacancies, line defects,grain boundaries, subgrain boundaries and amorphous regions. Pointdefects are defects on a size scale of no more than about four atomicspacings. A vacancy is the omission of an atom from its regular atomicsite in the crystal lattice. Line defects are defective regions (e.g.,edge dislocations, screw dislocations) that result in latticedistortions along a line (which may or may not be a straight line), andgenerally have a longer scale than point defects. In an edgedislocation, a lattice displacement is produced by a plane of atoms thatforms a terminus of the lattice. In a screw dislocation, part of thelattice is displaced with respect to an adjacent part of the lattice.Grain boundaries separate regions having different crystallographicorientation or misorientation (e.g., high angle grain boundaries, lowangle grain boundaries, including tilt boundaries and twist boundaries).Subgrain boundaries refer to low angle grain boundaries. An amorphousregion is a region that does not exhibit long range, ordered crystallinestructure. In certain embodiments, an atomically disordered, crystallinematerial (e.g., an atomically disordered, nanocrystalline material) hasa degree of atomic disorder that is about the same as the degree ofatomic disorder of the nanocrystalline silver coating of a member of theActicoat® family of dressings (Smith & Nephew, Hull, UK) (e.g., anActicoat® dressing, an Acticoat7® dressing, an Acticoat® moisturecoating dressing, an Acticoat® absorbent dressings). In someembodiments, an atomically disordered, crystalline material (e.g., anatomically disordered, nanocrystalline material) has a degree of atomicdisorder that is about the same as the degree of atomic disorder of thenanocrystalline silver coatings having a CZOI of at least fivemillimeters that are disclosed in the examples of Burrell et al., U.S.Pat. No. 5,958,440. In certain embodiments, an atomically disordered,crystalline material (e.g., an atomically disordered, nanocrystallinematerial), when contacted with an alcohol or water-based electrolyte, isreleased into the alcohol or water-based electrolyte (e.g., as ions,atoms, molecules and/or clusters) over a time scale of at least aboutone hour (e.g., at least about two hours, at least about 10 hours, atleast about a day). Examples of alcohols and/or water-based electrolytesinclude body fluids (e.g., blood, urine, saliva) and body tissue (e.g.,skin, muscle, bone).

[0041] As referred to herein, a nanocrystalline material is asingle-phase polycrystal or a multi-phase polycrystal having a maximumdimension of about 100 nanometers or less (e.g., about 90 nanometers orless, about 80 nanometers or less, about 70 nanometers or less, about 60nanometers or less, about 50 nanometers or less, about 40 nanometers orless, about 30 nanometers or less, about 25 nanometers or less) in atleast one dimension.

[0042] Examples of antimicrobial metal-containing materials (which mayor may not also be an atomically disordered crystalline material or ananocrystalline material) include antimicrobial silver-containingmaterials (e.g., antimicrobial silver, antimicrobial silver alloys,antimicrobial silver oxides, antimicrobial silver carbides,antimicrobial silver nitrides, antimicrobial silver borides,antimicrobial silver sulfides, antimicrobial silver myristates,antimicrobial silver stearates, antimicrobial silver oleates,antimicrobial silver glutonates, antimicrobial silver adipates,antimicrobial silver silicates, antimicrobial silver phosphides,antimicrobial silver halides, antimicrobial silver hydrides,antimicrobial silver nitrates, antimicrobial silver carbonates,antimicrobial silver sulfadiazines, antimicrobial silver acetates,antimicrobial silver lactates, antimicrobial silver citrates,antimicrobial alkali silver thiosulphates (e.g., antimicrobial sodiumsilver thiosulphate, antimicrobial potassium silver thiosulphate)),antimicrobial gold-containing materials (e.g., antimicrobial gold,antimicrobial gold alloys, antimicrobial gold oxides, antimicrobial goldcarbides, antimicrobial gold nitrides, antimicrobial gold borides,antimicrobial gold sulfides, antimicrobial gold myristates,antimicrobial gold stearates, antimicrobial gold oleates, antimicrobialgold glutonates, antimicrobial gold glutonates, antimicrobial goldadipates, antimicrobial gold silicates, antimicrobial gold phosphides,antimicrobial gold halides, antimicrobial gold hydrides, antimicrobialgold nitrates, antimicrobial gold carbonates, antimicrobial goldsulfadiazines, antimicrobial gold acetates, antimicrobial gold lactates,antimicrobial gold citrates, antimicrobial alkali gold thiosulphates(e.g., antimicrobial sodium gold thiosulphate, antimicrobial potassiumgold thiosulphate)), antimicrobial platinum-containing materials (e.g.,antimicrobial platinum, antimicrobial platinum alloys, antimicrobialplatinum oxides, antimicrobial platinum carbides, antimicrobial platinumnitrides, antimicrobial platinum borides, antimicrobial platinumsulfides, antimicrobial platinum myristates, antimicrobial platinumstearates, antimicrobial platinum oleates, antimicrobial platinumglutonates, antimicrobial platinum glutonates, antimicrobial platinumadipates, antimicrobial platinum silicates, antimicrobial platinumphosphides, antimicrobial platinum halides, antimicrobial platinumhydrides, antimicrobial platinum nitrates, antimicrobial platinumcarbonates, antimicrobial platinum sulfadiazines, antimicrobial platinumacetates, antimicrobial platinum lactates, antimicrobial platinumcitrates, antimicrobial alkali platinum thiosulphates (e.g.,antimicrobial sodium platinum thiosulphate, antimicrobial potassiumplatinum thiosulphate)), antimicrobial palladium-containing materials(e.g., antimicrobial palladium, antimicrobial palladium alloys,antimicrobial palladium oxides, antimicrobial palladium carbides,antimicrobial palladium nitrides, antimicrobial palladium borides,antimicrobial palladium sulfides, antimicrobial palladium myristates,antimicrobial palladium stearates, antimicrobial palladium oleates,antimicrobial palladium glutonates, antimicrobial palladium glutonates,antimicrobial palladium adipates, antimicrobial palladium silicates,antimicrobial palladium phosphides, antimicrobial palladium halides,antimicrobial palladium hydrides, antimicrobial palladium nitrates,antimicrobial palladium carbonates, antimicrobial palladiumsulfadiazines, antimicrobial palladium acetates, antimicrobial palladiumlactates, antimicrobial palladium citrates, antimicrobial alkalipalladium thiosulphates (e.g., antimicrobial sodium palladiumthiosulphate, antimicrobial potassium palladium thiosulphate)),antimicrobial iridium-containing materials (e.g., antimicrobial iridium,antimicrobial iridium alloys, antimicrobial iridium oxides,antimicrobial iridium carbides, antimicrobial iridium nitrides,antimicrobial iridium borides, antimicrobial iridium sulfides,antimicrobial iridium myristates, antimicrobial iridium stearates,antimicrobial iridium oleates, antimicrobial iridium glutonates,antimicrobial iridium glutonates, antimicrobial iridium adipates,antimicrobial iridium silicates, antimicrobial iridium phosphides,antimicrobial iridium halides, antimicrobial iridium hydrides,antimicrobial iridium nitrates, antimicrobial iridium carbonates,antimicrobial iridium sulfides, antimicrobial iridium sulfadiazines,antimicrobial iridium acetates, antimicrobial iridium lactates,antimicrobial iridium citrates, antimicrobial alkali iridiumthiosulphates (e.g., antimicrobial sodium iridium thiosulphate,antimicrobial potassium iridium thiosulphate)), antimicrobialzinc-containing materials (e.g., antimicrobial zinc, antimicrobial zincalloys, antimicrobial zinc oxides, antimicrobial zinc carbides,antimicrobial zinc nitrides, antimicrobial zinc borides, antimicrobialzinc sulfides, antimicrobial zinc myristates, antimicrobial zincstearates, antimicrobial zinc oleates, antimicrobial zinc glutonates,antimicrobial zinc glutonates, antimicrobial zinc adipates,antimicrobial zinc silicates, antimicrobial zinc phosphides,antimicrobial zinc halides, antimicrobial zinc hydrides, antimicrobialzinc nitrates, antimicrobial zinc carbonates, antimicrobial zincsulfides, antimicrobial zinc sulfadiazines, antimicrobial zinc acetates,antimicrobial zinc lactates, antimicrobial zinc citrates, antimicrobialalkali zinc thiosulphates (e.g., antimicrobial sodium zinc thiosulphate,antimicrobial potassium zinc thiosulphate)), antimicrobial coppercontaining materials (e.g., antimicrobial copper, antimicrobial copperalloys, antimicrobial copper oxides, antimicrobial copper carbides,antimicrobial copper nitrides, antimicrobial copper borides,antimicrobial copper sulfides, antimicrobial copper myristates,antimicrobial copper stearates, antimicrobial copper oleates,antimicrobial copper glutonates, antimicrobial copper glutonates,antimicrobial copper adipates, antimicrobial copper silicates,antimicrobial copper phosphides, antimicrobial copper halides,antimicrobial copper hydrides, antimicrobial copper nitrates,antimicrobial copper carbonates, antimicrobial copper sulfides,antimicrobial copper sulfadiazines, antimicrobial copper acetates,antimicrobial copper lactates, antimicrobial copper citrates,antimicrobial alkali copper thiosulphates (e.g., antimicrobial sodiumcopper thiosulphate, antimicrobial potassium copper thiosulphate)),antimicrobial tin-containing materials (e.g., antimicrobial tin,antimicrobial tin alloys, antimicrobial tin oxides, antimicrobial tincarbides, antimicrobial tin nitrides, antimicrobial tin borides,antimicrobial tin sulfides, antimicrobial tin myristates, antimicrobialtin stearates, antimicrobial tin oleates, antimicrobial tin glutonates,antimicrobial tin glutonates, antimicrobial tin adipates, antimicrobialtin silicates, antimicrobial tin phosphides, antimicrobial tin halides,antimicrobial tin hydrides, antimicrobial tin nitrates, antimicrobialtin carbonates, antimicrobial tin sulfides, antimicrobial tinsulfadiazines, antimicrobial tin acetates, antimicrobial tin lactates,antimicrobial tin citrates, antimicrobial alkali tin thiosulphates(e.g., antimicrobial sodium tin thiosulphate, antimicrobial potassiumtin thiosulphate)), antimicrobial antimony-containing materials (e.g.,antimicrobial antimony, antimicrobial antimony alloys, antimicrobialantimony oxides, antimicrobial antimony carbides, antimicrobial antimonynitrides, antimicrobial antimony borides, antimicrobial antimonysulfides, antimicrobial antimony myristates, antimicrobial antimonystearates, antimicrobial antimony oleates, antimicrobial antimonyglutonates, antimicrobial antimony glutonates, antimicrobial antimonyadipates, antimicrobial antimony silicates, antimicrobial antimonyphosphides, antimicrobial antimony halides, antimicrobial antimonyhydrides, antimicrobial antimony nitrates, antimicrobial antimonycarbonates, antimicrobial antimony sulfides, antimicrobial antimonysulfadiazines, antimicrobial antimony acetates, antimicrobial antimonylactates, antimicrobial antimony citrates, antimicrobial alkali antimonythiosulphates (e.g., antimicrobial sodium antimony thiosulphate,antimicrobial potassium antimony thiosulphate)), antimicrobial bismuthcontaining materials (e.g., antimicrobial bismuth, antimicrobial bismuthalloys, antimicrobial bismuth oxides, antimicrobial bismuth carbides,antimicrobial bismuth nitrides, antimicrobial bismuth borides,antimicrobial bismuth sulfides, antimicrobial bismuth myristates,antimicrobial bismuth stearates, antimicrobial bismuth oleates,antimicrobial bismuth glutonates, antimicrobial bismuth glutonates,antimicrobial bismuth adipates, antimicrobial bismuth silicates,antimicrobial bismuth phosphides, antimicrobial bismuth halides,antimicrobial bismuth hydrides, antimicrobial bismuth nitrates,antimicrobial bismuth carbonates, antimicrobial bismuth sulfides,antimicrobial bismuth sulfadiazines, antimicrobial bismuth acetates,antimicrobial bismuth lactates, antimicrobial bismuth citrates,antimicrobial alkali bismuth thiosulphates (e.g., antimicrobial sodiumbismuth thiosulphate, antimicrobial potassium bismuth thiosulphate)).

[0043] While the preceding paragraph lists certain metal-containingmaterials that are anti-microbial, similar metal-containing materials(oxides, carbides, nitrides, borides, sulfides, myristates, stearates,oleates, glutonates, adipates, silicates, phosphides, halides, hydrides,nitrates, hydroxides, carbonates, sulfides, sulfadiazines, acetates,lactates, citrates and/or alkali metal thiosulphates of silver, gold,palladium, platinum, tin, iridium, antimony, bismuth, copper, zinc) canbe anti-biofilm materials, antibacterial materials, anti-inflammatorymaterials, antifungal materials, antiviral materials, anti-autoimmunematerials, anti-cancer materials, pro-apoptosis materials,anti-proliferatives, and/or MMP modulating materials.

[0044] Examples of nanocrystalline metal-containing materials (which mayor may not also be an antimicrobial material or an atomically disorderedcrystalline material) include nanocrystalline silver-containingmaterials (e.g., nanocrystalline silver, nanocrystalline silver alloys,nanocrystalline silver oxides, nanocrystalline silver carbides,nanocrystalline silver nitrides, nanocrystalline silver borides,nanocrystalline silver sulfides, nanocrystalline silver halides,nanocrystalline silver myristates, nanocrystalline silver stearates,nanocrystalline silver oleates, nanocrystalline silver glutonates,nanocrystalline silver glutonates, nanocrystalline silver adipates,nanocrystalline silver silicates, nanocrystalline silver phosphides,nanocrystalline silver hydrides, nanocrystalline silver nitrates,nanocrystalline silver carbonates, nanocrystalline silver sulfides,nanocrystalline silver sulfadiazines, nanocrystalline silver acetates,nanocrystalline silver lactates, nanocrystalline silver citrates,nanocrystalline alkali silver thiosulphates (e.g., nanocrystallinesodium silver thiosulphate, nanocrystalline potassium silverthiosulphate)), nanocrystalline gold-containing materials (e.g.,nanocrystalline gold, nanocrystalline gold alloys, nanocrystalline goldoxides, nanocrystalline gold carbides, nanocrystalline gold nitrides,nanocrystalline gold borides, nanocrystalline gold sulfides,nanocrystalline gold halides, nanocrystalline gold hydrides,nanocrystalline gold nitrates, nanocrystalline gold myristates,nanocrystal line gold stearates, nanocrystalline gold oleates,nanocrystalline gold glutonates, nanocrystalline gold glutonates,nanocrystalline gold adipates, nanocrystalline gold silicates,nanocrystalline gold phosphides, nanocrystalline gold carbonates,nanocrystalline gold sulfides, nanocrystalline gold sulfadiazines,nanocrystalline gold acetates, nanocrystalline gold lactates,nanocrystalline gold citrates, nanocrystalline alkali gold thiosulphates(e.g., nanocrystalline sodium gold thiosulphate, nanocrystallinepotassium gold thiosulphate)), nanocrystalline platinum-containingmaterials (e.g., nanocrystalline platinum, nanocrystalline platinumalloys, nanocrystalline platinum oxides, nanocrystalline platinumcarbides, nanocrystalline platinum nitrides, nanocrystalline platinumborides, nanocrystalline platinum sulfides, nanocrystalline platinummyristates, nanocrystalline platinum stearates, nanocrystalline platinumoleates, nanocrystalline platinum glutonates, nanocrystalline platinumglutonates, nanocrystalline platinum adipates, nanocrystalline platinumsilicates, nanocrystalline platinum phosphides, nanocrystalline platinumhalides, nanocrystalline platinum hydrides, nanocrystalline platinumnitrates, nanocrystalline platinum carbonates, nanocrystalline platinumsulfides, nanocrystalline platinum sulfadiazines, nanocrystallineplatinum acetates, nanocrystalline platinum lactates, nanocrystallineplatinum citrates, nanocrystalline alkali platinum thiosulphates (e.g.,nanocrystalline sodium platinum thiosulphate, nanocrystalline potassiumplatinum thiosulphate)), nanocrystal line palladium-containing materials(e.g., nanocrystalline palladium, nanocrystalline palladium alloys,nanocrystalline palladium oxides, nanocrystalline palladium carbides,nanocrystalline palladium nitrides, nanocrystalline palladium borides,nanocrystalline palladium sulfides, nanocrystalline palladiummyristates, nanocrystalline palladium stearates, nanocrystallinepalladium oleates, nanocrystalline palladium glutonates, nanocrystallinepalladium glutonates, nanocrystalline palladium adipates,nanocrystalline palladium silicates, nanocrystalline palladiumphosphides, nanocrystalline palladium halides, nanocrystalline palladiumhydrides, nanocrystalline palladium nitrates, nanocrystalline palladiumcarbonates, nanocrystalline palladium sulfides, nanocrystallinepalladium sulfadiazines, nanocrystalline palladium acetates,nanocrystalline palladium lactates, nanocrystalline palladium citrates,nanocrystalline alkali palladium thiosulphates (e.g., nanocrystallinesodium palladium thiosulphate, nanocrystalline potassium palladiumthiosulphate)), nanocrystalline iridium-containing materials (e.g.,nanocrystalline iridium, nanocrystalline iridium alloys, nanocrystallineiridium oxides, nanocrystalline iridium carbides, nanocrystallineiridium nitrides, nanocrystalline iridium borides, nanocrystallineiridium sulfides, nanocrystalline iridium myristates, nanocrystallineiridium stearates, nanocrystalline iridium oleates, nanocrystallineiridium glutonates, nanocrystalline iridium glutonates, nanocrystallineiridium adipates, nanocrystalline iridium silicates, nanocrystallineiridium phosphides, nanocrystalline iridium halides, nanocrystallineiridium hydrides, nanocrystalline iridium nitrates, nanocrystallineiridium carbonates, nanocrystalline iridium sulfides, nanocrystallineiridium sulfadiazines, nanocrystalline iridium acetates, nanocrystallineiridium lactates, nanocrystalline iridium citrates, nanocrystallinealkali iridium thiosulphates (e.g., nanocrystalline sodium iridiumthiosulphate, nanocrystalline potassium iridium thiosulphate)),nanocrystalline zinc-containing materials (e.g., nanocrystalline zinc,nanocrystalline zinc alloys, nanocrystalline zinc oxides,nanocrystalline zinc carbides, nanocrystalline zinc nitrides,nanocrystalline zinc borides, nanocrystalline zinc sulfides,nanocrystalline zinc myristates, nanocrystalline zinc stearates,nanocrystalline zinc oleates, nanocrystalline zinc glutonates,nanocrystalline zinc glutonates, nanocrystalline zinc adipates,nanocrystalline zinc silicates, nanocrystalline zinc phosphides,nanocrystalline zinc halides, nanocrystalline zinc hydrides,nanocrystalline zinc nitrates, nanocrystalline zinc carbonates,nanocrystalline zinc sulfides, nanocrystalline zinc sulfadiazines,nanocrystalline zinc acetates, nanocrystalline zinc lactates,nanocrystalline zinc citrates, nanocrystalline alkali zinc thiosulphates(e.g., nanocrystalline sodium zinc thiosulphate, nanocrystallinepotassium zinc thiosulphate)), nanocrystalline copper-containingmaterials (e.g., nanocrystalline copper, nanocrystalline copper alloys,nanocrystalline copper oxides, nanocrystalline copper carbides,nanocrystalline copper nitrides, nanocrystalline copper borides,nanocrystalline copper sulfides, nanocrystalline copper myristates,nanocrystalline copper stearates, nanocrystalline copper oleates,nanocrystalline copper glutonates, nanocrystalline copper glutonates,nanocrystalline copper adipates, nanocrystalline copper silicates,nanocrystalline copper phosphides, nanocrystalline copper halides,nanocrystalline copper hydrides, nanocrystalline copper nitrates,nanocrystalline copper carbonates, nanocrystalline copper sulfadiazines,nanocrystalline copper acetates, nanocrystalline copper lactates,nanocrystalline copper citrates, nanocrystalline alkali copperthiosulphates (e.g., nanocrystalline sodium copper thiosulphate,nanocrystalline potassium copper thiosulphate)), nanocrystallinetin-containing materials (e.g., nanocrystalline tin, nanocrystalline tinalloys, nanocrystalline tin oxides, nanocrystalline tin carbides,nanocrystalline tin nitrides, nanocrystalline tin borides,nanocrystalline tin sulfides, nanocrystalline tin myristates,nanocrystalline tin stearates, nanocrystalline tin oleates,nanocrystalline tin glutonates, nanocrystalline tin glutonates,nanocrystalline tin adipates, nanocrystalline tin silicates,nanocrystalline tin phosphides, nanocrystalline tin halides,nanocrystalline tin hydrides, nanocrystalline tin nitrates,nanocrystalline tin carbonates, nanocrystalline tin sulfides,nanocrystalline tin sulfadiazines, nanocrystalline tin acetates,nanocrystalline tin lactates, nanocrystalline tin citrates,nanocrystalline alkali tin thiosulphates (e.g., nanocrystalline sodiumtin thiosulphate, nanocrystalline potassium tin thiosulphate)),nanocrystalline antimony-containing materials (e.g., nanocrystallineantimony, nanocrystalline antimony alloys, nanocrystalline antimonyoxides, nanocrystalline antimony carbides, nanocrystalline antimonynitrides, nanocrystalline antimony borides, nanocrystalline antimonysulfides, nanocrystalline antimony myristates, nanocrystalline antimonystearates, nanocrystalline antimony oleates, nanocrystalline antimonyglutonates, nanocrystalline antimony glutonates, nanocrystallineantimony adipates, nanocrystalline antimony silicates, nanocrystallineantimony phosphides, nanocrystalline antimony halides, nanocrystallineantimony hydrides, nanocrystalline antimony nitrates, nanocrystallineantimony carbonates, nanocrystalline antimony sulfides, nanocrystallineantimony sulfadiazines, nanocrystalline antimony acetates,nanocrystalline antimony lactates, nanocrystalline antimony citrates,nanocrystalline alkali antimony thiosulphates (e.g., nanocrystallinesodium antimony thiosulphate, nanocrystalline potassium antimonythiosulphate)), nanocrystalline bismuth containing materials (e.g.,nanocrystalline bismuth, nanocrystalline bismuth alloys, nanocrystallinebismuth oxides, nanocrystalline bismuth carbides, nanocrystallinebismuth nitrides, nanocrystalline bismuth borides, nanocrystallinebismuth sulfides, nanocrystalline bismuth myristates, nanocrystallinebismuth stearates, nanocrystalline bismuth oleates, nanocrystallinebismuth glutonates, nanocrystalline bismuth glutonates, nanocrystallinebismuth adipates, nanocrystalline bismuth silicates, nanocrystallinebismuth phosphides, nanocrystalline bismuth halides, nanocrystallinebismuth hydrides, nanocrystalline bismuth nitrates, nanocrystallinebismuth carbonates, nanocrystalline bismuth sulfides, nanocrystallineanti bismuth sulfadiazines, nanocrystalline bismuth acetates,nanocrystalline bismuth lactates, nanocrystalline bismuth citrates,nanocrystalline alkali bismuth thiosulphates (e.g., nanocrystallinesodium bismuth thiosulphate, nanocrystalline potassium bismuththiosulphate)).

[0045] Examples of atomically disordered, crystalline metal-containingmaterial (which may or may not also be an antimicrobial material or ananocrystalline material) include atomically disordered, crystallinesilver-containing materials (e.g., atomically disordered, crystallinesilver; atomically disordered, crystalline silver alloys; atomicallydisordered, crystalline silver oxides; atomically disordered,crystalline silver carbides; atomically disordered, crystalline silvernitrides; atomically disordered, crystalline silver borides; atomicallydisordered, crystalline silver sulfides; atomically disordered,crystalline silver myristates; atomically disordered, crystalline silverstearates; atomically disordered, crystalline silver oleates; atomicallydisordered, crystalline silver glutonates; atomically disordered,crystalline silver glutonates; atomically disordered, crystalline silveradipates; atomically disordered, crystalline silver silicates;atomically disordered, crystalline silver phosphides; atomicallydisordered, crystalline silver halides; atomically disordered,crystalline silver hydrides, atomically disordered, crystalline silvernitrates; atomically disordered, crystalline silver carbonates;atomically disordered, crystalline silver sulfides; atomicallydisordered, crystalline silver sulfadiazines; atomically disordered,crystalline silver acetates; atomically disordered, crystalline silverlactates; atomically disordered, crystalline silver citrates; atomicallydisordered, crystalline alkali silver thiosulphates (e.g., atomicallydisordered, crystalline sodium silver thiosulphate, atomicallydisordered, crystalline potassium silver thiosulphate)), atomicallydisordered, crystalline gold-containing materials (atomicallydisordered, crystalline gold; atomically disordered, crystalline goldalloys; atomically disordered, crystalline gold oxides; atomicallydisordered, crystalline gold carbides; atomically disordered,crystalline gold nitrides; atomically disordered, crystalline goldborides; atomically disordered, crystalline gold sulfides; atomicallydisordered, crystalline gold myristates; atomically disordered,crystalline gold stearates; atomically disordered, crystalline goldoleates; atomically disordered, crystalline gold glutonates; atomicallydisordered, crystalline gold glutonates; atomically disordered,crystalline gold adipates; atomically disordered, crystalline goldsilicates; atomically disordered, crystalline gold phosphides;atomically disordered, crystalline gold halides; atomically disordered,crystalline gold hydrides, atomically disordered, crystalline goldnitrates; atomically disordered, crystalline gold carbonates; atomicallydisordered, crystalline gold sulfides; atomically disordered,crystalline gold sulfadiazines; atomically disordered, crystalline goldacetates; atomically disordered, crystalline gold lactates; atomicallydisordered, crystalline gold citrates; atomically disordered,crystalline alkali gold thiosulphates (e.g., atomically disordered,crystalline sodium gold thiosulphate, atomically disordered, crystallinepotassium gold thiosulphate)), atomically disordered, crystallineplatinum-containing materials (e.g., atomically disordered, crystallineplatinum; atomically disordered, crystalline platinum alloys; atomicallydisordered, crystalline platinum oxides; atomically disordered,crystalline platinum carbides; atomically disordered, crystallineplatinum nitrides; atomically disordered, crystalline platinum borides;atomically disordered, crystalline platinum sulfides; atomicallydisordered, crystalline platinum myristates; atomically disordered,crystalline platinum stearates; atomically disordered, crystallineplatinum oleates; atomically disordered, crystalline platinumglutonates; atomically disordered, crystalline platinum glutonates;atomically disordered, crystalline platinum adipates; atomicallydisordered, crystalline platinum silicates; atomically disordered,crystalline platinum phosphides; atomically disordered, crystallineplatinum halides; atomically disordered, crystalline platinum hydrides,atomically disordered, crystalline platinum nitrates; atomicallydisordered, crystalline platinum carbonates; atomically disordered,crystalline platinum sulfides; atomically disordered, crystallineplatinum sulfadiazines; atomically disordered, crystalline platinumacetates; atomically disordered, crystalline platinum lactates;atomically disordered, crystalline platinum citrates; atomicallydisordered, crystalline alkali platinum thiosulphates (e.g., atomicallydisordered, crystalline sodium platinum thiosulphate, atomicallydisordered, crystalline potassium platinum thiosulphate), atomicallydisordered, crystalline palladium-containing materials (e.g., atomicallydisordered, crystalline palladium; atomically disordered, crystallinepalladium alloys; atomically disordered, crystalline palladium oxides;atomically disordered, crystalline palladium carbides; atomicallydisordered, crystalline palladium nitrides; atomically disordered,crystalline palladium borides; atomically disordered, crystallinepalladium sulfides; atomically disordered, crystalline palladiummyristates; atomically disordered, crystalline palladium stearates;atomically disordered, crystalline palladium oleates; atomicallydisordered, crystalline palladium glutonates; atomically disordered,crystalline palladium glutonates; atomically disordered, crystallinepalladium adipates; atomically disordered, crystalline palladiumsilicates; atomically disordered, crystalline palladium phosphides;atomically disordered, crystalline palladium halides; atomicallydisordered, crystalline palladium hydrides, atomically disordered,crystalline palladium nitrates; atomically disordered, crystallinepalladium carbonates; atomically disordered, crystalline palladiumsulfides; atomically disordered, crystalline palladium sulfadiazines;atomically disordered, crystalline palladium acetates; atomicallydisordered, crystalline palladium lactates; atomically disordered,crystalline palladium citrates; atomically disordered, crystallinealkali palladium thiosulphates (e.g., atomically disordered, crystallinesodium palladium thiosulphate, atomically disordered, crystallinepotassium palladium thiosulphate)), atomically disordered, crystallineiridium-containing materials (e.g., atomically disordered, crystallineiridium; atomically disordered, crystalline iridium alloys; atomicallydisordered, crystalline iridium oxides; atomically disordered,crystalline iridium carbides; atomically disordered, crystalline iridiumnitrides; atomically disordered, crystalline iridium borides; atomicallydisordered, crystalline iridium sulfides; atomically disordered,crystalline iridium myristates; atomically disordered, crystallineiridium stearates; atomically disordered, crystalline iridium oleates;atomically disordered, crystalline iridium glutonates; atomicallydisordered, crystalline iridium glutonates; atomically disordered,crystalline iridium adipates; atomically disordered, crystalline iridiumsilicates; atomically disordered, crystalline iridium phosphides;atomically disordered, crystalline iridium halides; atomicallydisordered, crystalline iridium hydrides, atomically disordered,crystalline iridium nitrates; atomically disordered, crystalline iridiumcarbonates; atomically disordered, crystalline iridium sulfides;atomically disordered, crystalline iridium sulfadiazines; atomicallydisordered, crystalline iridium acetates; atomically disordered,crystalline iridium lactates; atomically disordered, crystalline iridiumcitrates; atomically disordered, crystalline alkali iridiumthiosulphates (e.g., atomically disordered, crystalline sodium iridiumthiosulphate, atomically disordered, crystalline potassium iridiumthiosulphate)), atomically disordered, crystalline zinc-containingmaterials (e.g., atomically disordered, crystalline zinc; atomicallydisordered, crystalline zinc alloys; atomically disordered, crystallinezinc oxides; atomically disordered, crystalline zinc carbides;atomically disordered, crystalline zinc nitrides; atomically disordered,crystalline zinc borides; atomically disordered, crystalline zincsulfides; atomically disordered, crystalline zinc myristates; atomicallydisordered, crystalline zinc stearates; atomically disordered,crystalline zinc oleates; atomically disordered, crystalline zincglutonates; atomically disordered, crystalline zinc glutonates;atomically disordered, crystalline zinc adipates; atomically disordered,crystalline zinc silicates; atomically disordered, crystalline zincphosphides; atomically disordered, crystalline zinc halides; atomicallydisordered, crystalline zinc hydrides, atomically disordered,crystalline zinc nitrates; atomically disordered, crystalline zinccarbonates; atomically disordered, crystalline zinc sulfides; atomicallydisordered, crystalline zinc sulfadiazines; atomically disordered,crystalline zinc acetates; atomically disordered, crystalline zinclactates; atomically disordered, crystalline zinc citrates; atomicallydisordered, crystalline alkali zinc thiosulphates (e.g., atomicallydisordered, crystalline sodium zinc thiosulphate, atomically disordered,crystalline potassium zinc thiosulphate)), atomically disordered,crystalline copper-containing materials (e.g., atomically disordered,crystalline copper; atomically disordered, crystalline copper alloys;atomically disordered, crystalline copper oxides; atomically disordered,crystalline copper carbides; atomically disordered, crystalline coppernitrides; atomically disordered, crystalline copper borides; atomicallydisordered, crystalline copper sulfides; atomically disordered,crystalline copper myristates; atomically disordered, crystalline copperstearates; atomically disordered, crystalline copper oleates; atomicallydisordered, crystalline copper glutonates; atomically disordered,crystalline copper glutonates; atomically disordered, crystalline copperadipates; atomically disordered, crystalline copper silicates;atomically disordered, crystalline copper phosphides; atomicallydisordered, crystalline copper halides; atomically disordered,crystalline copper hydrides, atomically disordered, crystalline coppernitrates; atomically disordered, crystalline copper carbonates;atomically disordered, crystalline copper sulfides; atomicallydisordered, crystalline copper sulfadiazines; atomically disordered,crystalline copper acetates; atomically disordered, crystalline copperlactates; atomically disordered, crystalline copper citrates; atomicallydisordered, crystalline alkali copper thiosulphates (e.g., atomicallydisordered, crystalline sodium copper thiosulphate, atomicallydisordered, crystalline potassium copper thiosulphate)), atomicallydisordered, crystalline tin-containing materials (e.g., atomicallydisordered, crystalline tin; atomically disordered, crystalline tinalloys; atomically disordered, crystalline tin oxides; atomicallydisordered, crystalline tin carbides; atomically disordered, crystallinetin nitrides; atomically disordered, crystalline tin borides; atomicallydisordered, crystalline tin sulfides; atomically disordered, crystallinetin myristates; atomically disordered, crystalline tin stearates;atomically disordered, crystalline tin oleates; atomically disordered,crystalline tin glutonates; atomically disordered, crystalline tinglutonates; atomically disordered, crystalline tin adipates; atomicallydisordered, crystalline tin silicates; atomically disordered,crystalline tin phosphides; atomically disordered, crystalline tinhalides; atomically disordered, crystalline tin hydrides, atomicallydisordered, crystalline tin nitrates; atomically disordered, crystallinetin carbonates; atomically disordered, crystalline tin sulfides;atomically disordered, crystalline tin sulfadiazines; atomicallydisordered, crystalline tin acetates; atomically disordered, crystallinetin lactates; atomically disordered, crystalline tin citrates;atomically disordered, crystalline alkali tin thiosulphates (e.g.,atomically disordered, crystalline sodium tin thiosulphate, atomicallydisordered, crystalline potassium tin thiosulphate)), atomicallydisordered, crystalline antimony-containing materials (e.g., atomicallydisordered, crystalline antimony; atomically disordered, crystallineantimony alloys; atomically disordered, crystalline antimony oxides;atomically disordered, crystalline antimony carbides; atomicallydisordered, crystalline antimony nitrides; atomically disordered,crystalline antimony borides; atomically disordered, crystallineantimony sulfides; atomically disordered, crystalline antimonymyristates; atomically disordered, crystalline antimony stearates;atomically disordered, crystalline antimony oleates; atomicallydisordered, crystalline antimony glutonates; atomically disordered,crystalline antimony glutonates; atomically disordered, crystallineantimony adipates; atomically disordered, crystalline antimonysilicates; atomically disordered, crystalline antimony phosphides;atomically disordered, crystalline antimony halides; atomicallydisordered, crystalline antimony hydrides, atomically disordered,crystalline antimony nitrates; atomically disordered, crystallineantimony carbonates; atomically disordered, crystalline antimonysulfides; atomically disordered, crystalline antimony sulfadiazines;atomically disordered, crystalline antimony acetates; atomicallydisordered, crystalline go antimony ld lactates; atomically disordered,crystalline antimony citrates; atomically disordered, crystalline alkaliantimony thiosulphates (e.g., atomically disordered, crystalline sodiumantimony thiosulphate, atomically disordered, crystalline potassiumantimony thiosulphate)), atomically disordered, crystallinebismuth-containing materials (e.g., atomically disordered, crystallinebismuth; atomically disordered, crystalline bismuth alloys; atomicallydisordered, crystalline bismuth oxides; atomically disordered,crystalline bismuth carbides; atomically disordered, crystalline bismuthnitrides; atomically disordered, crystalline bismuth borides; atomicallydisordered, crystalline bismuth sulfides; atomically disordered,crystalline bismuth myristates; atomically disordered, crystallinebismuth stearates; atomically disordered, crystalline bismuth oleates;atomically disordered, crystalline bismuth glutonates; atomicallydisordered, crystalline bismuth glutonates; atomically disordered,crystalline bismuth adipates; atomically disordered, crystalline bismuthsilicates; atomically disordered, crystalline bismuth phosphides;atomically disordered, crystalline bismuth halides; atomicallydisordered, crystalline bismuth hydrides, atomically disordered,crystalline bismuth nitrates; atomically disordered, crystalline bismuthcarbonates; atomically disordered, crystalline bismuth sulfides;atomically disordered, crystalline bismuth sulfadiazines; atomicallydisordered, crystalline bismuth acetates; atomically disordered,crystalline bismuth lactates; atomically disordered, crystalline bismuthcitrates; atomically disordered, crystalline alkali bismuththiosulphates (e.g., atomically disordered, crystalline sodium bismuththiosulphate, atomically disordered, crystalline potassium bismuththiosulphate)).

[0046] Subjects

[0047] The metal-containing material can be used to treat, for example ahuman or an animal (e.g., a dog, a cat, a horse, a bird, a reptile, anamphibian, a fish, a turtle, a guinea pig, a hamster, a rodent, a cow, apig, a goat, a primate, a monkey, a chicken, a turkey, a buffalo, anostrich, a sheep, a llama).

[0048] Conditions and Condition Locations

[0049] The conditions that can be treated with the metal-containingmaterial include, for example, bacterial conditions, microbialconditions, biofilm conditions, inflammatory conditions, fungalconditions, viral conditions, autoimmune conditions, idiopathicconditions, hyperproliferative conditions, noncancerous growths and/orcancerous conditions (e.g., tumorous conditions, hematologicmalignancies). Such conditions can be associated with, for example, oneor more prions, parasites, fungi, viruses and/or bacteria. In general,the location of the condition to be treated corresponds to the type ofcondition to be treated.

[0050] In some embodiments, the condition can be a skin condition or aintegument condition (e.g., a bacterial skin condition, a microbial skincondition, a biofilm skin condition, an inflammatory skin condition, ahyperproliferative skin condition, a fungal skin condition, a viral skincondition, an autoimmune skin condition, an idiopathic skin condition, ahyperproliferative skin condition, a cancerous skin condition, amicrobial integument condition, an inflammatory integument condition, afungal integument condition, a viral integument condition, an autoimmuneintegument condition, an idiopathic integument condition, ahyperproliferative integument condition, a cancerous integumentcondition). Examples of skin conditions or integument conditions includebums, eczema (e.g., atopic eczema, acrodermatitis continua, contactallergic dermatitis, contact irritant dermatitis, dyshidrotic eczema,pompholyx, lichen simplex chronicus, nummular eczema, seborrheicdermatitis, stasis eczema), erythroderma, insect bites, mycosisfungoides, pyoderma gangrenosum, eythrema multiforme, rosacea, ungualand subungual diseases (e.g., onychomycosis, tinea unguim infection,psoriasis of the unguis, eczema of the unguis, lichen planus of theunguis, viral warts of the unguis), acne (e.g., acne vulgaris, neonatalacne, infantile acne, pomade acne), psoriasis, Reiter's syndrome,pityriasis rubra pilaris, hyperpigmentation, vitiligo, scarringconditions (e.g., hypertropic scarring), keloids, lichen planus,age-related skin disorders (e.g., wrinkles, cellulite) andhyperproliferative skin disorders, such as, for example,hyperproliferative variants of the disorders of keratinization (e.g.,actinic keratosis, senile keratosis). Generally, the treatment of skinor integument conditions involves contacting the metal-containingmaterial with the area of the skin having the condition. As an example,a skin or integument condition can be treated by contacting the area ofskin having the condition with a dressing having a coating of themetal-containing material. As another example, a skin or integumentcondition can be treated by contacting the area of skin having thecondition with a solution containing the metal-containing material. Asan additional example, a skin or integument condition can be treated bycontacting the area of skin having the condition with a pharmaceuticalcarrier composition containing the metal-containing material. In thecase of onychomycosis, the material may be applied to the nail in anappropriate form (see below) such that the material penetrates the hardnail to contact the affected area.

[0051] In certain embodiments, the condition can be a respiratorycondition (e.g., a bacterial respiratory condition, a biofilmrespiratory condition, a microbial respiratory condition, aninflammatory respiratory condition, a fungal respiratory condition, aviral respiratory condition, an autoimmune respiratory condition, anidiopathic respiratory condition, a hyperproliferative respiratorycondition, a cancerous respiratory condition). Examples of respiratoryconditions include asthma, emphysema, bronchitis, pulmonary edema, acuterespiratory distress syndrome, bronchopulmonary dysplasia, fibroticconditions (e.g., pulmonary fibrosis), pulmonary atelectasis,tuberculosis, pneumonia, sinusitis, allergic rhinitis, pharyngitis,mucositis, stomatitis, chronic obstructive pulmonary disease,bronchiectasis, lupus pneumonitis and cystic fibrosis. In general, thetreatment of respiratory conditions involves contacting themetal-containing material with the area of the respiratory system havingthe condition. Areas of the respiratory system include, for example, theoral cavity, the nasal cavity, and the lungs. As an example, certainrespiratory conditions can be treated by inhaling a free standing powderof the metal-containing material (e.g., with a dry powder inhaler). Asanother example, certain respiratory conditions can be treated byinhaling an aerosol containing the metal-containing material (e.g., withan inhaler).

[0052] In some embodiments, the condition can be a musculo-skeletalcondition (e.g., a bacterial musculo-skeletal condition, a biofilmmusculo-skeletal condition, a microbial musculo-skeletal condition, aninflammatory musculo-skeletal condition, a fungal musculo-skeletalcondition, a viral musculo-skeletal condition, an autoimmunemusculo-skeletal condition, an idiopathic musculo-skeletal condition, ahyperproliferative musculo-skeletal condition, a cancerousmusculo-skeletal condition). A musculo-skeletal condition can be, forexample, a degenerative musculo-skeletal condition (e.g., arthritis) ora traumatic musculo-skeletal condition (e.g., a torn or damaged muscle).Examples of musculo-skeletal conditions include tendonitis,osteomyelitis, fibromyalgia, bursitis and arthritis. Generally, thetreatment of musculo-skeletal conditions involves contacting themetal-containing material with the area of the musculo-skeletal systemhaving the condition. Areas of the musculo-skeletal system include, forexample, the joints, the muscles, and the tendons. As an example,certain musculo-skeletal conditions can be treated by injecting (e.g.,via a small needle injector) a solution containing the metal-containingmaterial into the subject. As another example, certain musculo-skeletalconditions can be treated by injecting (e.g., via a needleless injector)a free standing powder of the metal-containing material into thesubject. Needleless injectors are disclosed, for example, in U.S. Pat.Nos. 4,596,556; 4,790,824; 5,064,413; 5,312,335; 5,383,851; 5,399,163;5,520,639; 6,096,002; and Des. 349,958, which are hereby incorporated byreference. As an additional example, certain musculo-skeletal conditionscan be treated by using a pharmaceutical carrier composition of themetal-containing material, such as a penetrating pharmaceutical carriercomposition of the metal-containing material (e.g., a compositioncontaining DMSO).

[0053] In certain embodiments, the condition can be a circulatorycondition (e.g., a bacterial circulatory condition, a biofilmcirculatory condition, a microbial circulatory condition, aninflammatory circulatory condition, a fungal circulatory condition, aviral circulatory condition, an autoimmune circulatory condition, anidiopathic circulatory condition, a hyperproliferative circulatorycondition, a cancerous circulatory condition). As referred to herein,circulatory conditions include lymphatic conditions. Examples ofcirculatory conditions include arteriosclerosis, lymphoma, septicemia,leukemia, ischemic vascular disease, lymphangitis and atherosclerosis.In general, the treatment of circulatory conditions involves contactingthe metal-containing material with the area of the circulatory systemhaving the condition. Areas of the circulatory system include, forexample, the heart, the lymphatic system, blood, blood vessels (e.g.,arteries, veins). As an example, certain circulatory conditions can betreated by injecting (e.g., via a small needle injector) a solutioncontaining the metal-containing material into the subject. As anotherexample, certain circulatory conditions can be treated by injecting(e.g., via a needleless injector) a free standing powder of themetal-containing material into the subject.

[0054] In some embodiments, the condition can be a mucosal or serosalcondition (e.g., a bacterial mucosal or serosal condition, a biofilmmucosal or serosal condition, a microbial mucosal or serosal condition,an inflammatory mucosal or serosal condition, a fungal mucosal orserosal condition, a viral mucosal or serosal condition, an autoimmunemucosal or serosal condition, an idiopathic mucosal or serosalcondition, a hyperproliferative mucosal or serosal condition, acancerous mucosal or serosal condition). Examples of mucosal or serosalconditions include pericarditis, Bowen's disease, stomatitis,prostatitis, sinusitis, allergic rhinitis, digestive disorders, pepticulcers, esophageal ulcers, gastric ulcers, duodenal ulcer, espohagitis,gastritis, enteritis, enterogastric intestinal hemorrhage, toxicepidermal necrolysis syndrome, Stevens Johnson syndrome, fibroticcondition (e.g., cystic fibrosis), bronchitis, pneumonia (e.g.,nosocomial pneumonia, ventilator-assisted pneumonia), pharyngitis,common cold, ear infections, sore throat, sexually transmitted diseases(e.g., syphilis, gonorrhea, herpes, genital warts, HIV, chlamydia),inflammatory bowel disease, colitis, hemorrhoids, thrush, dentalconditions, oral conditions, conjunctivitis, and periodontal conditions.Generally, the treatment of mucosal or serosal conditions involvescontacting the metal-containing material with the area of a mucosal orserosal region having the condition. Mucosal or serosal areas include,for example, the oral cavity, the nasal cavity, the colon, the smallintestine, the large intestine, the stomach, and the esophagus. As anexample, certain mucosal or serosal conditions can be treated byinhaling a free standing powder of the metal-containing material (e.g.,with a dry powder inhaler). As another example, certain mucosal orserosal conditions can be treated by inhaling an aerosol containing themetal-containing material (e.g., with an inhaler). As an additionalexample, certain mucosal or serosal conditions can be treated bygargling or spraying a solution of the metal-containing material. Asanother example, certain mucosal or serosal conditions can be treatedusing a suppository. As a further example, certain mucosal or serosalconditions can be treated by an enema.

[0055] In embodiments in which the metal-containing material is used totreat hyperproliferation of cell growth (e.g., cancerous conditions,such as malignant tumors, or non-cancerous conditions, such as benigntumors), the metal-containing material can be used to induce apoptosis(programmed cell death), modulate matrix metalloproteinases (MMPs)and/or modulates cytokines by contacting affected tissue (e.g., ahyperplastic tissue, a tumor tissue or a cancerous lesion) with themetal-containing material. It has been observed that themetal-containing material (e.g., an antimicrobial, anti-biofilm,antibacterial, anti-inflammatory, antifungal, antiviral,anti-autoimmune, anti-cancer, pro-apoptosis, anti-proliferative, and/orMMP modulating, nanocrystalline and/or atomically disordered,silver-containing material) can be effective in preventing production ofa high number of MMPs and/or cytokines by certain cells withoutnecessarily reducing MMP and/or cytokine production by the same cells toabout zero. It is believed, however, that in certain embodiments, themetal-containing material can be used to inhibit MMP and/or cytokineproduction (e.g., bring MMP and/or cytokine production to normal levels,desired levels, and/or about zero) in certain cells.

[0056] MMPs refer to any protease of the family of MMPs which areinvolved in the degradation of connective tissues, such as collagen,elastins, fibronectin, laminin, and other components of theextracellular matrix, and associated with conditions in which excessivedegradation of extracellular matrix occurs, such as tumor invasion andmetastasis. Examples of MMPs include MMP-2 (secreted by fibroblasts anda wide variety of other cell types) and MMP-9 (released by mononuclearphagocytes, neutrophils, corneal epithelial cells, tumor cells,cytotrophoblasts and keratinocytes).

[0057] Cytokine refers to a nonimmunoglobulin polypeptide secreted bymonocytes and lymphocytes in response to interaction with a specificantigen, a nonspecific antigen, or a nonspecific soluble stimulus (e.g.,endotoxin, other cytokines). Cytokines affect the magnitude ofinflammatory or immune responses. Cytokines can be divided into severalgroups, which include interferons, tumor necrosis factor (TNF),interleukins (IL-1 to IL-8), transforming growth factors, and thehematopoietic colony-stimulating factors. An example of a cytokine isTNF-α. A fibroblast is an area connective tissue cell which is aflat-elongated cell with cytoplasmic processes at each end having aflat, oval vesicular nucleus. Fibroblasts which differentiate intochondroblasts, collagenoblasts, and osteoblasts form the fibrous tissuesin the body, tendons, aponeuroses, supporting and binding tissues of allsorts. Hyperplastic tissue refers to tissue in which there is anabnormal multiplication or increase in the number of cells in a normalarrangement in normal tissue or an organ. A tumor refers to spontaneousgrowth of tissue in which multiplication of cells is abnormal,uncontrolled and progressive. A tumor generally serves no usefulfunction and grows at the expense of the healthy organism. A cancerouslesion is a tumor of epithelial tissue, or malignant, new growth made upof epithelial cells tending to infiltrate surrounding tissues and togive rise to metastases. As used in reference to the skin, a cancerouslesion means a lesion which may be a result of a primary cancer, or ametastasis to the site from a local tumor or from a tumor in a distantsite. It may take the form of a cavity, an open area on the surface ofthe skin, skin nodules, or a nodular growth extending from the surfaceof the skin.

[0058] Conditions characterized by undesirable MMP activity includeulcers, asthma, acute respiratory distress syndrome, skin disorders,skin aging, keratoconus, restenosis, osteo- and rheumatoid arthritis,degenerative joint disease, bone disease, wounds, cancer including cellproliferation, invasiveness, metastasis (carcinoma, fibrosarcoma,osteosarcoma), hypovolemic shock, periodontal disease, epidermolysisbullosa, scleritis, atherosclerosis, multiple sclerosis, inflammatorydiseases of the central nervous system, vascular leakage syndrome,collagenase induced disease, adhesions of the peritoneum, strictures ofthe esophagus or bowel, ureteral or urethral strictures, and biliarystrictures. Excessive TNF production has been reported in diseases whichare characterized by excessive MMP activity, such as autoimmune disease,cancer, cachexia, HIV infection, and cardiovascular conditions.

[0059] Forms of the Material and Methods of Applying the Material

[0060] In general, the metal-containing material can be in any desiredform or formulation. For example, the material can be a coating on asubstrate (e.g., in the form of a dressing, a coated medical implant), afree standing powder, a solution, or disposed within a pharmaceuticallyacceptable carrier.

[0061] In some embodiments, the metal-containing material can act as apreservative. In such embodiments, a form or formulation containing themetal-containing material can be prepared with or without additionalpreservatives. Moreover, in embodiments in which the metal-containingmaterial acts as a preservative, the metal-containing material may beincluded in a therapeutic formulation containing other therapeuticagents (e.g., the metal-containing material may be included primarily incertain therapeutic compositions to act as a preservative).

[0062] Moreover, the material can be applied to the subject in any of avariety of ways, generally depending upon the form of the material asapplied and/or the location of the condition to be treated. In general,the amount of material used is selected so that the desired therapeuticeffect (e.g., reduction in the condition being treated) is achievedwhile the material introduces an acceptable level of toxicity (e.g.,little or no toxicity) to the subject. Generally, the amount of thematerial used will vary with the conditions being treated, the stage ofadvancement of the condition, the age and type of host, and the type,concentration and form of the material as applied. Appropriate amountsin any given instance will be readily apparent to those skilled in theart or capable of determination by routine experimentation. In someembodiments, a single application of the material may be sufficient. Incertain embodiments, the material may be applied repeatedly over aperiod of time, such as several times a day for a period of days, weeks,months or years.

[0063] Substrate Coatings

[0064] Examples of commercially available metal-containing materialsinclude the Acticoat® family of dressings (Smith & Nephew, Hull, UK),which are formed of antimicrobial, anti-inflammatory atomicallydisordered, nanocrystalline silver-containing material coated on one ormore substrates. Such dressings include the Acticoat® dressings, theActicoat7® dressings, the Acticoat® moisture coating dressings, and theActicoat® absorbent dressings.

[0065] A coating of a metal-containing material (e.g., an antimicrobial,atomically disordered, nanocrystalline silver-containing material) canbe formed on a substrate using a desired technique. In certainembodiments, the coating is formed by depositing the material on thesubstrate surface using chemical vapor deposition, physical vapordeposition, and/or liquid phase deposition. Exemplary deposition methodsinclude vacuum evaporation deposition, arc evaporation deposition,sputter deposition, magnetron sputter deposition and ion plating.

[0066] In some embodiments, the coating is prepared using physical vapordeposition. FIG. 1 shows a vapor deposition system 100 that includes avacuum chamber 110, an energy source 120 (e.g., an electron beam source,an ion source, a laser beam, a magnetron source), a target 130 and asubstrate 140. During operation, energy source 120 directs a beam ofenergy 122 to target 130, causing material 132 to be removed (e.g., byevaporation) from target 130 and directed to a surface 142 of substrate140. At least a portion of the removed material 132 is deposited onsurface 142.

[0067] In general, the values of the system parameters (e.g., thetemperature of surface 142, the pressure of chamber 110, the angle ofincidence of removed material 132 on surface 142, the distance betweentarget 130 and surface 142) can be selected as desired. The temperatureof surface 142 can be relatively low during the deposition process. Forexample, during the deposition process, the ratio of the temperature ofsubstrate 140 to the melting point of the material forming target 130(as determined in using Kelvin) can be about 0.5 or less (e.g., about0.4 or less, about 0.35 or less, about 0.3 or less).

[0068] The pressure in chamber 110 can be relatively high. For example,vacuum evaporation deposition, electron beam deposition or arcevaporation, the pressure can be about 0.01 milliTorr or greater. Forgas scattering evaporation (pressure plating) or reactive arcevaporation, the pressure in chamber 110 can be about 20 milliTorr orgreater. For sputter deposition, the pressure in chamber 110 can beabout 75 millitorr or greater. For magnetron sputter deposition, thepressure in chamber 110 can be about 10 milliTorr or greater. For ionplating, the pressure in chamber 110 can be 200 milliTorr or greater.

[0069] The angle of incidence of removed material 132 on surface 142 (θ)can be relatively low. For example, the angle of incidence of removedmaterial 132 on surface 142 can be about 75° or less (e.g., about 60° orless, about 45° or less, about 30° or less).

[0070] The distance between target 130 and surface 142 can be selectedbased upon the values of the other system parameters. For example, thedistance between target 130 and surface 142 can be about 250 millimetersor less (e.g., about 150 millimeters or less, 125 millimeters or less,about 100 millimeters or less, about 90 millimeters or less, about 80millimeters or less, about 70 millimeters or less, about 60 millimetersor less, about 50 millimeters or less, about 40 millimeters or less).

[0071] As noted above, it is believed that, the metal-containingmaterial, when contacted with an alcohol or water-based electrolyte, canbe released into the alcohol or water-based electrolyte (e.g., as ions,atoms, molecules and/or clusters). It is also believed that the abilityto release the metal (e.g., as atoms, ions, molecules and/or clusters)on a sustainable basis from a coating is generally dependent upon anumber of factors, including coating characteristics such ascomposition, structure, solubility and thickness, and the nature of theenvironment in which the device is used. As the level of atomic disorderis increased, it is believed that the amount of metal species releasedper unit time increases. For example, a silver metal film deposited bymagnetron sputtering at a ratio of substrate temperature to the targetmelting point of less than about 0.5 and a working gas pressure of about0.93 Pascals (about seven milliTorr) releases approximately ⅓ of thesilver ions that a film deposited under similar conditions, but at fourPascals (about 30 milliTorr), will release over 10 days. Coatings formedwith an intermediate structure (e.g., lower pressure, lower angle ofincidence etc.) have been observed to have metal (e.g., silver) releasevalues intermediate to these values as determined by bioassays. Ingeneral, to obtain relatively slow release of the metal, the coatingshould have a relatively low degree of atomic disorder, and, to obtainrelatively fast release of the metal, the coating should have arelatively high degree of atomic disorder.

[0072] For continuous, uniform coatings, the time for total dissolutionis generally a function of coating thickness and the nature of theenvironment to which the coating is exposed. The release of metal isbelieved to increase approximately linearly as the thickness of thecoating is increased. For example, it has been observed that a two foldincrease in coating thickness can result in about a two fold increase inlongevity.

[0073] In certain embodiments, it is possible to manipulate the degreeof atomic disorder, and therefore the metal release from a coating, byforming a thin film coating with a modulated structure. For example, acoating deposited by magnetron sputtering such that the working gaspressure was relatively low (e.g., about two Pascals or about 15milliTorr) for about 50% of the deposition time and relatively high(e.g., about four Pascals or 30 milliTorr) for the remaining time, canresult in a relatively rapid initial release of metal (e.g., ions,clusters, atoms, molecules), followed by a longer period of slowrelease. This type of coating is can be particularly effective ondevices such as urinary catheters for which an initial rapid release isadvantageous to achieve quick antimicrobial concentrations followed by alower release rate to sustain the concentration of metal (e.g., ions,clusters, atoms, molecules) over a period of weeks.

[0074] It is further believed that the degree of atomic disorder of acoating can be manipulated by introducing one or more dissimilarmaterials into the coating. For example, one or more gases can bepresent in chamber 110 during the deposition process.

[0075] Examples of such gases include oxygen-containing gases (e.g.,oxygen, air, water), nitrogen-containing gases (e.g., nitrogen),hydrogen-containing gases (e.g., water, hydrogen), boron-containinggases (e.g., boron), sulfur-containing gases (e.g., sulfur),carbon-containing gases (e.g., carbon monoxide, carbon dioxide),phosphorus-containing gases, silicon-containing gases, andhalogen-containing gases (e.g., fluorine, chlorine, bromine, iodine).The additional gas(es) can be co-deposited or reactively deposited withmaterial 132. This can result in the deposition/formation of an oxide,hydroxide, nitride, carbide, phosphide, silicate, boride, sulfide,hydride, nitrate, carbonate, alkali thiosulphate (e.g., sodiumthiosulphate, potassium thiosulphate), myristate, sorbate, stearate,oleate, glutonate, adipate, silicate, phosphide, sulfadiazine, acetate,lactate, citrate and/or halide material (e.g., an oxide of ametal-containing material, a hydroxide of a metal-containing material, anitride of a metal-containing material, a carbide of a metal-containingmaterial, a phosphide of a metal-containing material, a silicate of ametal-containing material, a boride of a metal-containing material, asulfide of a metal-containing material, a hydride of a metal-containingmaterial, a halide of a metal-containing material, a nitrate of ametal-containing material, a carbonate of a metal-containing material, amyristate of a metal-containing material, a sorbate of ametal-containing material, a stearate of a metal-containing material, anoleate of a metal-containing material, a glutonate of a metal-containingmaterial, an adipate of a metal-containing material, a silicate of ametal-containing material, a phosphide of a metal-containing material, asulfide of a metal-containing material, a sulfadiazine of ametal-containing material, a sulfadiazine of a metal-containingmaterial, an acetate of a metal-containing material, a lactate of ametal-containing material, a citrate of a metal-containing material, analkali metal thiosulphate (e.g., sodium metal thiosulphate, potassiummetal thiosulphate) of a metal-containing material). Without wishing tobe bound by theory, it is believed that atoms and/or molecules of theadditional gas(es) may become absorbed or trapped in the material,resulting in enhanced atomic disorder. The additional gas(es) may becontinuously supplied during deposition, or may be pulsed to (e.g., forsequential deposition). In embodiments, the material formed can beconstituted of a material with a ratio of material 132 to additionalgas(es) of about 0.2 or greater. The presence of dissimilar atoms ormolecules in the coating can enhance the degree of atomic disorder ofthe coating due to the difference in atomic radii of the dissimilarconstituents in the coating.

[0076] The presence of dissimilar atoms or molecules in the coating mayalso be achieved by co-depositing or sequentially depositing one or moreadditional metal elements (e.g., one or more additional antimicrobialmetal elements). Such additional metal elements include, for example,Au, Pt, Ta, Ti, Nb, Zn, V, Hf, Mo, Si, Al, and other transition metalelements. It is believed that the presence of dissimilar metal elements(one or more primary metal elements and one or more additional metalelements) in the coating can reduce atomic diffusion and stabilize theatomically disordered structure of the coating. A coating containingdissimilar metal elements can be formed, for example, using thin filmdeposition equipment with multiple targets. In some embodiments,sequentially deposited layers of the metal elements are discontinuous(e.g., islands within a the primary metal). In certain embodiments, theweight ratio of the additional metal(s) to the primary metal(s) isgreater than about 0.2.

[0077] While FIG. 1 shows one embodiment of a deposition system, otherembodiments are possible. For example, the deposition system can bedesigned such that during operation the substrate moves along rollers.Additionally or alternatively, the deposition system may containmultiple energy sources, multiple targets, and/or multiple substrates.The multiple energy sources, targets and/or substrates can be, forexample, positioned in a line, can be staggered, or can be in an array.

[0078] In certain embodiments, two layers of the material are depositedon the substrate to achieve an optical interference effect.Alternatively, the two layers can be formed of different materials, withthe outer (top) of the two layers being formed of an antimicrobial,atomically disordered, nanocrystalline silver-containing material, andthe inner of the two layers having appropriate reflective properties sothat the two layers can provide an interference effect (e.g., to monitorthe thickness of the outer (top) of the two layers). The substrate canbe selected as desired. The substrate may be formed of one layer ormultiple layers, which may be formed of the same or different materials.

[0079] In certain embodiments, the substrate can include one or morelayers containing a bioabsorbable material. Bioabsorbable materials aredisclosed, for example, in U.S. Pat. No. 5,423,859. In general,bioabsorbable materials can include natural bioabsorbable polymers,biosynethetic bioabsorbable polymers and synthetic bioabsorbablepolymers. Examples of synthetic bioabsorbable polymers includepolyesters and polylactones (e.g., polymers of polyglycolic acid,polymers of glycolide, polymers of lactic acid, polymers of lactide,polymers of dioxanone, polymers of trimethylene carbonate,polyanhydrides, polyesteramides, polyortheoesters, polyphosphazenes, andcopolymers of the foregoing). Examples of natural bioabsorbable polymersinclude proteins (e.g., albumin, fibrin, collagen, elastin),polysaccharides (e.g., chitosan, alginates, hyaluronic acid). Examplesof biosynthetic polymers include polyesters (e.g., 3-hydroxybutyratepolymers).

[0080] In some embodiments, the substrate includes multiple layers(e.g., two layers, three layers, four layers, five layers, six layers,seven layers, eight layers, nine layers, 10 layers). The layers can belaminated together (e.g., by thermal fusing, stitching and/or ultrasonicwelding).

[0081] One or more layers (e.g., an outer layer) of a multi-layersubstrate can be formed of a perforated (and optionally non-adherent)material (e.g., a woven material or a non-woven material) that can allowfluid to penetrate or diffuse therethrough. Such materials include, forexample, cotton, gauze, polymeric nets (e.g., polyethylene nets, nylonnets, polypropylene nets, polyester nets, polyurethane nets,polybutadiene nets), polymeric meshes (e.g., polyethylene meshes, nylonmeshes, polypropylene meshes, polyester meshes, polyurethane meshes,polybutadiene meshes) and foams (e.g., an open cell polyurethane foam).Examples of commercially available materials include DELNET™ P530non-woven polyethylene veil (Applied Extrusion Technologies, Inc.,Middletown, Del.), Exu-Dry CONFORMANT2™ non-woven polyethylene veil(Frass Survival Systems, Inc., NY, N.Y.), CARELLE™ material (CarolinaFormed Fabrics Corp.), NYLON90™ material (Carolina Formed FabricsCorp.), N-TERFACE™ material (Winfield Laboratories, Inc., Richardson,Tex.), HYPOL™ hydrophilic polyurethane foam (W.R. Grace & Co., NY,N.Y.).

[0082] One or more layers (e.g., an inner layer) of a multi-layersubstrate can be formed of an absorbent material (e.g., a woven materialor a non-woven material) formed of, for example, rayon, polyester, arayon/polyester blend, polyester/cotton, cotton and/or cellulosicfibers. Examples include creped cellulose wadding, air felt, air laidpulp fibers and gauze. An example of a commercially available materialis SONATRA™ 8411 70/30 rayon/polyester blend (Dupont Canada,Mississauga, Ontario).

[0083] One or more layers (e.g., an outer layer) of a multi-layersubstrate can be formed of an occlusive or semi-occlusive material, suchas an adhesive tape or polyurethane film (e.g., to secure the device tothe skin and/or to retain moisture).

[0084] In some embodiments, the layers in a multi-layer substrate arelaminated together (e.g., at intermittent spaced locations) byultrasonic welds. Typically, heat (e.g., generated ultrasonically) andpressure are applied to either side of the substrate at localized spotsthrough an ultrasonic horn so as to cause flowing of at least one of theplastic materials in the first and second layers and the subsequentbonding together of the layers on cooling. The welds can be formed aslocalized spots (e.g., circular spots). The spots can have a diameter ofabout 0.5 centimeter or less.

[0085] The shape of the substrate can generally be varied as desired.For example, the substrate can be in the shape of a film, a fiber or apowder.

[0086] The substrate/coating article can be used in a variety ofarticles. For example, the article can be in the shape of a medicaldevice. Exemplary medical devices include wound closure devices (e.g.,sutures, staples, adhesives), tissue repair devices (e.g., meshes, suchas meshes for hernia repair), prosthetic devices (e.g., internal bonefixation devices, physical barriers for guided bone regeneration,stents, valves, electrodes), tissue engineering devices (e.g., for usewith a blood vessel, skin, a bone, cartilage, a liver), controlled drugdelivery systems (e.g., microcapsules, ion-exchange resins) and woundcoverings and/or fillers (e.g., alginate dressings, chitosan powders).In some embodiments, the article is a transcutaneous medical device(e.g., a catheter, a pin, an implant), which can include thesubstrate/coating supported on, for example, a solid material (e.g., ametal, an alloy, latex, nylon, silicone, polyester and/or polyurethane).In some embodiments, the article is in the form of a patch (e.g., apatch having an adhesive layer for adhering to the skin, such as atransdermal patch).

[0087] Subsequent to deposition, the material can optionally beannealed. In general, the anneal is conducted under conditions toincrease the stability (e.g., shelf life) of the material whilemaintaining the desired therapeutic activity of the material. In certainembodiments, the material can be annealed at a temperature of about 200°C. or less (e.g., about room temperature).

[0088] The substrate/coating is typically sterilized prior to use (e.g.,without applying sufficient thermal energy to anneal out the atomicdisorder). The energy used for sterilization can be, for example, gammaradiation or electron beam radiation. In some embodiments, ethyleneoxide sterilization techniques are used to sterilize thesubstrate/coating.

[0089] Free Standing Powders

[0090] A free standing powder can be prepared by, for example, coldworking or compressing to impart atomic disorder to the powder. Incertain embodiments, a free standing powder is prepared by forming acoating of the material as described above, and then removing thematerial from the surface of the substrate. For example, the materialcan be scraped from the surface of the substrate by one or morescrapers. In embodiments in which the substrate moves during depositionof the material, the scrapers can remove the material as the substratemoves. The scrapers can be, for example, suspended above the substrate.Such scrapers can be, for example, weighted and/or spring loaded toapply pressure sufficient to remove the material as the substrate moves.In some embodiments (e.g., when a continuous belt is used), the scraperscan be located above the end rollers to remove the material with areverse dragging action as the substrate rounds the end roller.

[0091] A free standing powder can be used to treat a condition invarious ways. As an example, the powder can sprinkled onto the subject'sskin. As another example, the powder can be inhaled using an inhaler,such as a dry powder inhaler. In some embodiments, a dry powder can bein the form of an aerosol, which contains, for example, at least about10 (e.g., at least about 20, at least about 30) weight percent and/or atmost about 99 (e.g., at most about 90, at most about 80, at most about70, at most about 60, at most about 50) weight percent of the drypowder.

[0092] In certain embodiments (e.g., when the free standing powder isinhaled), the average particle size of the free standing powder isselected to reduce the likelihood of adverse reaction(s) of theparticles in the tissue and/or to deposit the powder onto specificanatomical locations (e.g., tissue contacted by the free standing powderduring inhalation). In some embodiments, the average particle size isselected (e.g., less than about 10 microns) so that a relatively smallamount of the particles get into the lower respiratory tract. Inembodiments, a free standing powder can have an average particle size ofless than about 10 microns (e.g., less than about eight microns, lessthan about five microns, less than about two microns, less than aboutone micron, less than about 0.5 micron) and/or at least about 0.01micron (e.g., at least about 0.1 micron, at least about 0.5 micron).

[0093] Powder Impregnated Materials

[0094] The metal-containing material can be in the form of a powderimpregnated material. Such powder impregnated materials can, forexample, be in the form of a hydrocolloid having the free standingpowder blended therein. A powder impregnated material can be, forexample, in the form of a dressing, such as a hydrocolloid dressing.

[0095] Solutions

[0096] The material can be in the form of a solution (e.g., asolvent-based solution). The solution can be formed, for example, bydissolving a free standing powder of the material in a solvent for thepowder. As an example, a container (e.g., a tea bag-type container) withthe free standing powder within it can be immersed in the water orsolvent. As another example, a substrate (e.g., in the form of a stripor a bandage) carrying the material can be immersed in the solvent. Incertain embodiments, it can be preferable to form a solution bydissolving a free standing powder of the material in a solvent becausethis can be a relatively convenient approach to forming a solution. Asolution also refers to a suspension that contains one or moremetal-containing materials. As an example, a suspension can be formed bydissolving a metal-containing material (e.g., a nanocrystallinesilver-containing material) in a liquid (e.g., water) for a period oftime (e.g., several days) so that particles of the metal-containingmaterial are suspended (e.g., by Brownian motion) in the liquid. In someembodiments, a suspended particle of metal-containing material can have,for example, a diameter of the order of from about 10 nanometers toabout 20 nanometers. A solution also refers to a dispersion thatcontains one or more metal-containing materials.

[0097] In certain embodiments, the solution containing the material iscontacted with the subject relatively soon after formation of thesolution. For example, the solution containing the material can becontacted with the subject within about one minute or less (e.g., withinabout 30 seconds or less, within about 10 seconds or less) of formingthe solution containing the material. In some embodiments, a longerperiod of time lapses before the solution containing the material iscontacted with the subject. For example a period of time of at leastabout 1.5 minutes (e.g., at least about five minutes, at least about 10minutes, at least about 30 minutes, at least about one hour, at leastabout 10 hours, at least about a day, at least about a week) lapsesbetween the time the solution containing the material is formed and thesolution containing the material is contacted with the subject.

[0098] In some embodiments, lowering the pH of the solution (e.g., toless than about 6.5, such as from about 3.5 to about 6.5) can allow fora higher concentration of the dissolved material and/or a faster rate ofdissolution. The pH of the solution can be lowered, for example, byadding acid to the solution (e.g., by adding CO₂ to the solution to formcarbonic acid).

[0099] A solution containing the material can be contacted with thesubject with or without the use of a device. As an example, a solutioncontaining the material can be contacted with the skin, mouth, ears oreyes as a rinse, a bath, a wash, a gargle, a spray, and/or drops. Asanother example, the solution can be injected using a small needleinjector and/or a needleless injector. As an additional example, asolution containing the material can be formed into an aerosol (e.g., anaerosol prepared by a mechanical mister, such as a spray bottle or anebulizer), and the aerosol can be contacted with the subject using anappropriate device (e.g., a hand held inhaler, a mechanical mister, aspray bottle, a nebulizer, an oxygen tent). As a further example, asolution containing the material can be contacted with the secondlocation via a catheter.

[0100] In embodiments in which onychomycosis is being treated, themethod can include first hydrating the nail with urea (1-40%) or lacticacid (10-15%), followed by treatment with the metal-containing material,which may contain an appropriate solvent (e.g., DMSO) for penetrationthrough the nail. Alternatively or additionally, onychomycosis can betreated by injecting (e.g., via a needleless injector and/or a needle)the metal-containing material to the affected area.

[0101] Typically, the solvent is a relatively hydrophilic solvent.Examples of solvents include water, DMSO and alcohols. In certainembodiments, a water-based solution is a buffered solution. In someembodiments, a water-based solution contains carbonated water. Inembodiments, more than one solvent can be used.

[0102] In some embodiments, the solution can contain about 0.001 weightpercent or more (e.g., about 0.01 weight percent or more, about 0.02weight percent or more, about 0.05 weight percent or more, about 0.1weight percent or more, about 0.2 weight percent or more, about 0.5weight percent or more, about one weight percent or more) of thematerial and/or about 10 weight percent or less (e.g., about five weightpercent or less, about four weight percent or less, about three weightpercent or less, about two weight percent or less, about one weightpercent or less) of the material.

[0103] Pharmaceutical Carrier Compositions

[0104] The metal-containing material can disposed (e.g., suspended)within a pharmaceutically acceptable carrier. The formulation can be,for example, a semi-solid, a water-based hydrocolloid, an oil-in-wateremulsion, a water-in-oil emulsion, a non-dried gel, and/or a dried gel.Typically, when disposed in a pharmaceutically acceptable carrier, themetal-containing material is applied to the skin.

[0105] Examples of pharmaceutically acceptable carriers include creams,ointments, gels, sprays, solutions, drops, powders, lotions, pastes,foams and liposomes.

[0106] The formulation can contain about 0.01 weight percent or more(e.g., about 0.1 weight percent or more, about 0.5 weight percent ormore, about 0.75 weight percent or more, about one weight percent ormore, about two weight percent or more, about five weight percent ormore, about 10 weight percent or more) of the metal-containing materialand/or about 50 weight percent or less (e.g., about 40 weight percent orless, about 30 weight percent or less, about 20 weight percent or less,about 20 weight percent or less, about 15 weight percent or less, about10 weight percent or less, about five weight percent or less) of themetal-containing material.

[0107] In certain embodiments, the metal-containing material can beeffectively used in the oral cavity when in the form of an article(e.g., a tape, a pill, a capsule, a tablet or lozenge) that is placedwithin the oral cavity (e.g., so that the subject can suck on the tape,pill, capsule, tablet or lozenge). In some embodiments, the article canbe a sustained release article (e.g., a sustained release capsule) whichcan allow the metal-containing material to be released at apredetermined rate (e.g., a relatively constant rate). In someembodiments, an article can include a material (e.g., in the form of acoating and/or in the form of a matrix material) that allows the articleto pass through certain portions of the gastrointestinal system withrelatively little (e.g., no) release of the metal-containing material,but that allows a relatively large amount of the metal-containingmaterial to be released in a desired portion of the gastrointestinalsystem. As an example, the article can be an enteric article (e.g., anenteric coated tablet) so that the article to passes through the stomachwith little (e.g., no) metal-containing material being released, and sothat the metal-containing material is relatively easily released by thearticle in the intestines.

[0108] Formulations can optionally include one or more components whichcan be biologically active or biologically inactive. Examples of suchoptional components include base components (e.g., water and/or an oil,such as liquid paraffin, vegetable oil, peanut oil, castor oil, cocoabutter), thickening agents (aluminum stearate, hydrogen lanolin),gelling agents, stabilizing agents, emulsifying agents, dispersingagents, suspending agents, thickening agents, coloring agents, perfumes,excipients (starch, tragacanth, cellulose derivatives, polyethyleneglycols, silicones, bentonites, silicic acid, talc), foaming agents(e.g., surfactants), surface active agents, preservatives (e.g., methylparaben, propyl paraben) and cytoconductive agents (e.g., betaglucan).In some embodiments, a formulation includes petrolatum. In certainembodiments, a pharmaceutical carrier composition can include aconstituent (e.g., DMSO) to assist in the penetration of skin.

[0109] While the foregoing has described embodiments in which a singlecondition is treated, in some embodiments multiple conditions can betreated. The multiple conditions can be the same type of condition(e.g., multiple skin or integument conditions) or different types ofconditions. For example, a dressing formed of one or more substratescoated with an appropriate metal-containing material (e.g.,antimicrobial, atomically disordered, silver-containing material) can beapplied to an area of the skin having multiple skin or integumentconditions (e.g., a bum and psoriasis) so that the metal-containingmaterial treats the multiple skin or integument conditions.

[0110] Moreover, while the foregoing has described embodiments thatinvolve one method of contacting a subject with the metal-containingmaterial, in other embodiments, more than one method of contacting asubject with the metal-containing material can be used. For example, themethods can include one or more of ingestion (e.g., oral ingestion),injection (e.g., using a needle, using a needleless injector), topicaladministration, inhalation (e.g., inhalation of a dry powder, inhalationof an aerosol) and/or application of a dressing.

[0111] Furthermore, while the foregoing has described embodiments inwhich one form of the metal-containing material is used, in otherembodiments, more than one form of the metal-containing material can beused. For example, the methods can include using the metal-containingmaterial in the form of a coating (e.g., a dressing), a free standingpowder, a solution and/or a pharmaceutical carrier composition.

[0112] Moreover, the metal-containing material can be used in variousindustrial applications. For example, the metal-containing material canbe used to reduce and/or prevent microbial growth on industrial surfaces(e.g., industrial surfaces where microbial growth may occur, such aswarm and/or moist surfaces). Examples of industrial surfaces includeheating pipes and furnace filters. In certain embodiments, themetal-containing material can be disposed (e.g., coated or sprayed) onthe surface of interest to reduce and/or prevent microbial growth. Thiscan be advantageous in preventing the spread of microbes via, forexample, heating and/or air circulation systems within buildings.

[0113] In addition, while using a needleless injector to inject certaincompounds to treat one or more ungual and/or subungual diseases (e.g.,onychomycosis, tinea unguim infection, psoriasis of the unguis, eczemaof the unguis, lichen planus of the unguis, viral warts of the unguis)has been discussed, a needleless injector can also be used to deliverone or more other compounds to treat one or more ungual and/or subungualdiseases. Such compounds can include compounds that are used (e.g.,systemically, topically) to treat ungual and/or subungual diseases(e.g., by interacting with one or more fungi that can cause certainungual and/or subungual diseases, such as candida albicana, trichophytonrubrum, trichophytron interdigitale and/or scopulariopsisbrevicaullis,). Examples of compounds include griseofulvin, terbinafine,citopirox, itraconazole, and ketoconazole. As an example, in embodimentsin which the disease is a fungal disease, the compound can be ananti-fungal compound. As another example, in embodiments in which thedisease is psoriasis of the unguis, the compound can be ananti-psoriatic compound. As a further example, in embodiments in whichthe disease is eczema of the unguis, the compound can be an anti-eczemacompound. As an additional example, in embodiments in which the diseaseis lichen planus of the unguis, the compound can be an anti-lichenplanus compound. As another example, in embodiments in which the diseaseis viral warts of the unguis, the compound can be an anti-viralcompound. In general, the methods can include using a needlelessinjector to deliver one or more compounds to, into and/or through anarea of the subject, such as an unguis (e.g., a toe nail, a finger nail,a hoof, a claw) and/or tissue (e.g., skin tissue) adjacent an unguis,that is associated with an ungual and/or subungual disease.

[0114] Moreover, while certain techniques have been described that canbe used to deliver a compound for the treatment of an ungual orsubungual disease, other techniques can also be used. As an example,iontophoresis can be used to deliver a compound to treat an ungualand/or subungual infection.

[0115] The following examples are illustrative and not intended aslimiting.

Examples

[0116] Treatment of Hyperproliferative Skin Conditions

Example 1 Preparation of Nanocrystalline Silver Coatings on Dressings

[0117] This example shows the preparation of a bilayer nanocrystallinesilver coating on a dressing material. A high density polyethylenedressing, DELNET™ or CONFORMANT 2™ was coated with a silver base layerand a silver/oxide top layer to generate a coloured anti-microbialcoating having indicator value. The coating layers were formed bymagnetron sputtering under the conditions set out in the followingtable. Sputtering Conditions: Base Layer Top Layer Target 99.99% Ag99.99% Ag Target Size 20.3 cm diameter 20.3 cm diameter Working Gas 96/4wt % Ar/O₂ 96/4 wt % Ar/O₂ Working Gas Pressure 5.33 Pa (40 mT) 5.33 Pa(40 mT) Power 0.3 kW 0.15 kW Substrate Temperature 20° C. 20° C. BasePressure 3.0 × 10⁻⁶ Torr 3.0 × 10⁻⁶ Torr Anode/Cathode Distance 100 mm100 mm Sputtering Time 7.5-9 min 1.5 min Voltage 369-373 V 346 V

[0118] The resulting coating was blue in appearance. A fingertip touchwas sufficient to cause a colour change to yellow. The base layer wasabout 900 nm thick, while the top layer was 100 nm thick.

[0119] To establish that silver species were released from the coateddressings, a zone of inhibition test was conducted. Mueller Hinton agarwas dispensed into Petri dishes. The agar plates were allowed to surfacedry prior to being inoculated with a lawn of Staphylococcus aureusATCC#25923. The inoculant was prepared from Bactrol Discs (Difco, M.),which were reconstituted as per the manufacturer's directions.Immediately after inoculation, the coated materials to be tested wereplaced on the surface of the agar. The dishes were incubated for 24 hr.at 37° C. After this incubation period, the zone of inhibition wascalculated (corrected zone of inhibition=zone of inhibition−diameter ofthe test material in contact with the agar). The results showed acorrected ZOI of about 10 mm, demonstrating good release of silverspecies.

[0120] The coating was analyzed by nitric acid digestion and atomicabsorption analysis to contain 0.24+/−0.04 mg silver per mg high densitypolyethylene. The coating was a binary alloy of silver (>97%) and oxygenwith negligible contaminants, based on secondary ion mass spectroscopy.The coating, as viewed by SEM, was highly porous and consisted ofequiaxed nanocrystals organized into coarse columnar structures with anaverage grain size of 10 nm. Silver release studies in waterdemonstrated that silver was released continuously from the coatinguntil an equilibrium concentration of about 66 mg/L was reached(determined by atomic absorption), a level that is 50 to 100 timeshigher than is expected from bulk silver metal (solubility≦1 mg/L).

[0121] By varying the coating conditions for the top layer to lengthenthe sputtering time to 2 min, 15 sec., a yellow coating was produced.The top layer had a thickness of about 140 nm and went through a colourchange to purple with a fingertip touch. Similarly, a purple coating wasproduced by shortening the sputtering time to 1 min, to achieve a toplayer thickness of about 65 nm. A fingertip touch caused a colour changeto yellow.

[0122] To form a three layer dressing, two layers of this coateddressing material were placed above and below an absorbent core materialformed from needle punched rayon/polyester (SONTARA™ 8411). With thesilver coating on both the first and third layers, the dressing may beused with either the blue coating side or the silver side in the skinfacing position. For indicator value, it might be preferable to have theblue coating visible. The three layers were laminated together byultasonic welding to produce welds between all three layers spaced atabout 2.5 cm intervals across the dressing. This allowed the dressing tobe cut down to about 2.5 cm size portions for smaller dressing needswhile still providing at least one weld in the dressing portion.

[0123] The coated dressings were sterilized using gamma radiation and asterilization dose of 25 kGy. The finished dressing was packagedindividually in sealed polyester peelable pouches, and has shown a shelflife greater than 1 year in this form. The coated dressings can be cutin ready to use sizes, such as 5.1×10.2 cm strips, and slits formedtherein before packaging. Alternatively, the dressings may be packagedwith instructions for the clinician to cut the dressing to size and formthe desired length of the slit for the medical device.

[0124] Additional silver coated dressings were prepared in a full scaleroll coater under conditions to provide coatings having the sameproperties set out above, as follows:

[0125] the dressing material included a first layer of silver coatedDELNET, as set out above, laminated to STRATEX, AET, 8.0NP₂-A/QW, whichis a layer of 100% rayon on a polyurethane film.

[0126] Silver Foam Dressing—three layers of silver coated high densitypolyethylene prepared as above, alternating with two layers ofpolyurethane foam, L-00562-6 Medical Foam, available from Rynel Ltd.,Bootbay, Me., USA.

Example 2 Preparation of Nanocrystalline Silver Powders

[0127] Nanocrystalline silver powder was prepared by preparing silvercoatings on silicon wafers, under the conditions set forth in the tableabove, and then scraping the coating off using a glass blade.

[0128] Nanocrystalline silver powder was also prepared by sputteringsilver coatings on silicon wafers using Westaim Biomedical NGRC unit,and then scraping the coating off. The sputtering conditions were asfollows: Target: 99.99% Ag Target Size: 15.24 cm × 1216.125 cm WorkingGas: 75:25 wt % Ar/O₂ Working Gas Pressure: 40 mTorr Total Current: 40 ABase Pressure: 5.0 × 10⁻⁵ Torr Sandvik Belt Speed: 340 mm/min Voltage:370 V

[0129] The powder has a particle size ranging from 2 μm to 100 μm, withcrystallite size of 8 to 10 nm, and demonstrated a positive restpotential.

Example 3 Treatment of Psoriasis

[0130] This patient was a 58 year old female with psoriatic plaquescovering up to sixty percent of her body. For this patient, psoriaticplaques first occurred ten years ago and have been treated with thefollowing:

[0131] 1. Adrenal corticosteroids. Injections gave relief from pruritusand general discomfort. Treatments led to a rebound effect; i.e.psoriasis would flare up after treatments wore off. Corticosteroids werediscontinued.

[0132] 2. UV Light and Methotrexate treatments. UV light treatments weregiven in conjunction with methotrexate. The UV light treatments causedbums and new lesions. The methotrexate caused severe nausea. Bothtreatments were discontinued.

[0133] 3. Ice Cap Spray. This treatment contained a potentcorticosteroid, and gave some relief but it was taken off the market andis no longer available.

[0134] 4. Soriatone (acetretin 10 mg). This systemic retinoid treatmentwas associated with joint aches and was discontinued.

[0135] 5. Diet. The patient was attempting to control the diseasethrough diet.

[0136] Nanocrystalline silver was tested as follows. Nanocrystallinesilver was deposited on sheets of high-density polyethylene (HDPE) usinga vapour deposition process as set forth in

[0137] Example 1. Two sheets of this coated HDPE were laminated togetheraround a core of non-woven rayon polyester, as set forth in Example 1. A50 mm×50 mm (2″×2″) piece of this composite material was saturated withwater and placed centrally on a one and a half year old 150 mm×100 mm(6″×4″) psoriatic plaque on the patient's flank. The nanocrystallinesilver coated material was covered with a piece of low moisture vapourtransmission thin polymer film. The polymer sheet extended 50 mm (2″)beyond the nanocrystalline silver coated HDPE to provide control dataregarding occlusion of the psoriatic plaque.

[0138] The dressing was removed after three days. There was nodiscernible change in the plaque at this time. However two days laterthe area that was covered with the nanocrystalline silver had theappearance of normal skin while the rest of the plaque was still roughand unchanged, including the untreated but occluded area.

[0139] The nanocrystalline silver therapy caused the treated psoriaticplaque to resolve.

Example 4 Treatment of Psoriasis

[0140] The subject was a 58 year old female with psoriatic plaques overup to sixty percent of her body. Psoriatic plaques had first occurred 10years ago and had been treated with the following:

[0141] 1. Adrenal corticosteroids. Injections gave relief from pruritusand general discomfort. Treatments led to a rebound effect i.e.psoriasis would flare up after treatments wore off. Corticosteroids werediscontinued.

[0142] 2. UV Light and Methotrexate treatments. UV light treatments weregiven in conjunction with methotrexate. The UV light treatments causedburns and new lesions. The methotrexate caused severe nausea. Bothtreatments were discontinued.

[0143] 3. Ice Cap Spray. This treatment contained a potentcorticosteroid, and gave some relief but it was taken off the market andis no longer available.

[0144] 4. Soriatone (acetretin 10 mg). This systemic retinoid treatmentwas associated with joint aches and was discontinued.

[0145] 5. Diet. The patient was attempting to control the diseasethrough diet.

[0146] Nanocrystalline silver was tested as follows. Nanocrystallinesilver was deposited on sheets of high-density polyethylene (HDPE) usinga vapour deposition process as set forth in Example 1 (top layer). Twosheets of this coated HDPE were laminated together around a core ofnon-woven rayon polyester, as set forth in Example 1. A 50 mm×50 mm(2″×2″) piece of this composite material was saturated with water andplaced centrally on a 125 mm×100 mm (5″×4″) psoriatic plaque on thepatient's upper left thigh. The nanocrystalline silver coated materialwas covered with a piece of low moisture vapour transmission thinpolymer film. The polymer sheet extended 50 mm (2″) beyond thenanocrystalline silver coated HDPE to provide control data regardingocclusion of the psoriatic plaque.

[0147] The dressing was removed and the plaque examined after two days.The area that was covered with the nanocrystalline silver was free ofscaling and only slightly erythematous while the rest of the plaque wasstill erythenatous and scaly, including the untreated but occluded area.The plaque was redressed with a similar 50 mm×50 mm (2″×2″) piece ofnanocrystalline silver coated dressing, which was left in place for afurther period of 2 days. The area that was covered with thenanocrystalline silver remained free of scale and only slightlyerythenatous, while the rest of the plaque was still erythenatous andscaly, including the area under the occlusive film.

[0148] The nanocrystalline silver therapy caused the treated psoriaticplaque to resolve.

Example 5 Preparation of Nanocrystalline Gels

[0149] A commercial carboxymethyl cellulose/pectin (Duoderm Convatec™)was combined with nanocrystalline silver powder prepared as in Example 2to produce a gel with 0.1% w/v. silver. Carboxymethyl cellulose (CMC)fibers were coated by magnetron sputtering, under conditions similar tothose set out in Example 1 for the top layer to produce a defectivenanocrystalline silver coating. The CMC was then gelled in water byadding 2.9 g to 100 mL volume. An alginate fibrous substrate wasdirectly coated with a defective nanocrystalline silver coating bymagnetron sputtering under coating conditions similar to those set forthin Example 1 for the top layer. The alginate (5.7 g) was added to 100 mLvolume of water to create a gel. A commercial gel containing CMC andalginate (Purilon gel Coloplast™) was mixed with an atomic disorderednanocrystalline silver powder prepared as in Example 2 to give a gelproduct with 0.1% w/v silver. A commercially available gel(Lubriderm™—glyceryl polymethacrylate) was blended with atomicdisordered nanocrystalline silver powder prepared as in Example 2, toprepare a gel with a silver content of 0.1% w/v. A further gel wasformulated with, on w/v basis, 0.1% methyl paraben, 0.02% propylparaben, 0.5% polyvinyl alcohol (Airvol™ PVA 540), 2% CMC, 0.1%nanocrystalline silver powder prepared as in Example 2, and was broughtup to 1000 g with water.

[0150] Treatment of Inflammatory Skin Conditions

Example 1 Preparation of Nanocrystalline Silver Coatings on Dressings

[0151] This example shows the preparation of a bilayer nanocrystallinesilver coating on a dressing material. A high density polyethylenedressing, DELNET™ or CONFORMANT 2™ was coated with a silver base layerand a silver/oxide top layer to generate a coloured antimicrobialcoating having indicator value as described in Example 1 of theTreatment of Hyperproliferative Skin conditions examples. The coatinglayers were formed by magnetron sputtering under the conditions set outin the following table.

Example 2 Preparation of Nanocrystalline Silver Coating on HDPE Mesh

[0152] The silver coated mesh was produced, as set forth in Example 1,by sputtering silver onto Delnet, a HDPE mesh (Applied ExtrusionTechnologies, Inc., Middletown, Del., USA) using Westaim Biomedical TMRCunit under the following conditions: Target: 99.99% Ag Target Size:15.24 cm × 152.4 cm Working Gas: 99.375:0.625 wt % Ar/O₂ Working GasPressure: 5.33 Pascals (40 mTorr) Total Current: 22 A Base Pressure: 5.0× 10⁻⁵ Torr Sandvik Belt Speed: 577 mm/min Voltage: 367 V

[0153] The coating was tested and found to have a weight ratio ofreaction product to silver of between 0.05 and 0.1. The dressing wasnon-staining to human skin.

Example 3 Preparation of Atomic Disordered Nanocrystalline SilverPowders

[0154] Nanocrystalline silver coatings were prepared by sputteringsilver in an oxygen-containing atmosphere directly onto an endlessstainless steel belt of a magnetron sputtering roll coater, or ontosilicon wafers on the belt. The belt did not need to be cooled. Thecoatings were scraped off with the belt with suspended metal scrapers asthe belt rounded the end rollers. For the coated silicon wafers, thecoatings were scraped off with a knife edge. The sputtering conditionswere as follows: Target: 99.99% Ag Target Size: 15.24 cm × 1216.125 cmWorking Gas: 75:25 wt % Ar/O₂ Working Gas Pressure: 5.33 Pascals (40milliTorr) Total Current: 40 A Base Pressure: 5.0 × 10⁻⁵ Torr (range: 1× 10⁻⁴-9 × 10⁻⁷ Torr or 1 × 10⁻²-1.2 × 10⁻⁴ Pa) Sandvik Belt Speed: 340mm/min Voltage: 370 V

[0155] The powder had a particle size ranging from 2 μm to 100 μm, withgrain or crystallite size of 8 to 10 nm (i.e., nanocrystalline), anddemonstrated a positive rest potential.

[0156] Similar atomic disordered nanocrystalline silver powders wereformed as set forth hereinabove by magnetron sputtering onto cooledsteel collectors, under conditions taught in the prior Burrell et al.patents to produce atomic disorder.

Example 4 In vitro Activity of Silver Solution against Propionibacteriumacne

[0157] An in vitro test was conducted to determine if silver solutionsaccording to the present invention effectively control Propionibacteriumacne. The silver solution was obtained by static elution of Acticoat™Burn Wound Dressing (lot #: 00403A-05, Westaim Biomedical Corp., FortSaskatchewan, Canada) with nanopure water in a ratio of one square inchof dressing in five milliliters of water for 24 hours at roomtemperature. The silver concentration of the silver solution wasdetermined by an atomic absorption method. The silver elute was dilutedwith nanopure water to 20 μg/ml. The Propionibacterium acne (ATCC No.0919) was provided by Biofilm Research Group, University of Calgary.

[0158] The inoculum was prepared by inoculating freshly autoclaved andcooled tubes of Tryptic soy broth (TSB) with P. acne and incubating themfor 2 days at 37° C. in an anaerobic jar. At this time, the opticaldensity of the suspensions was ˜0.3 at a wavelength of 625 nm.

[0159] The bacterial suspension (100 μL) was mixed with 100 μL of thesilver solution being tested. The final concentration of silver in thesemixtures was 10 μg/ml. The mixtures were incubated in an anaerobic jarat 37° C. for two hours. The silver was neutralized by addition of 0.4%STS (0.85% NaCl, 0.4% Sodium thioglycolate, 1% Tween™ 20) and thesolution was serially 10-fold diluted with phosphate-buffered saline. 20μL aliquots of the original solution and subsequent dilutions wereplated onto TSA drop plates. The drops were allowed to dry and theplates were incubated in an anaerobic jar at 37° C. for 72 hours atwhich time the colonies were counted. The control consisted of 100 μL ofbacterial suspension mixed with 100 μL of nanopure water and treated asabove.

[0160] The results showed that the silver solution according to thepresent invention, at a final concentration of 10 μg/ml, gave 4.3logarithm reduction in viable P. acne counts in two hours.

Example 5 Treatment of Acne

[0161] A sixteen year old female was diagnosed with acne vulgaris. Shehad numerous red papules and pustules on her forehead. Various skincleansing regimes and antibiotic (erythromycin and clindomycin)treatments had been tried and had failed to control the acne. Prior tobedtime, the papules and pustules on one side of her forehead weremoistened and covered with a nanocrystalline silver coated high densitypolyethylene mesh, prepared as in Example 1 (single layer, bluecoating). The mesh was then occluded with a thin film dressing whichremained in place for 10 hours. Upon removal, the papules and pustuleswere no longer red and were only slightly raised. Some brown staining ofthe skin was observed.

Example 6 Treatment of Acne

[0162] A sixteen year old male was diagnosed with acne vulgaris. He hadnumerous raised, red papules and pustules on his forehead. Various skincleansing regimes and antibiotic treatments had been tried and hadfailed to control the acne. The patient was placed on isotretinointreatment which controlled his acne well. He did develop a single largepustule on his forehead which was embarrassing for him. Prior tobedtime, the pustule was moistened and covered with a nanocrystallinesilver coated high density polyethylene mesh prepared as in Example 2.The mesh was then occluded with a thin film dressing which remained inplace for 10 hours. Upon removal the pustule was no longer red and wasonly slightly raised. A second treatment resulted in the disappearanceof the pustule.

Example 7 Treatment of Acne

[0163] A sixteen year old female was diagnosed with acne vulgaris. Shehad numerous red papules and pustules on her forehead. Various skincleansing regimes and antibiotic (erythromycin and clindomycin)treatments had been tried and had failed to control the acne. Prior tobedtime, the papules and pustules on one side of her forehead weremoistened and covered with a nanocrystalline silver coated high densitypolyethylene mesh, prepared as in Example 2. The mesh was then occludedwith a thin film dressing which remained in place for 10 hours. Uponremoval the papules and pustules were no longer red and were onlyslightly raised. A second treatment resulted in the disappearance of thepapules and virtual elimination of the pustules. The silver coated mesh,when prepared as set forth in Example 2, did not result in any stainingof the skin.

Example 8 Treatment of Adult Acne with Silver-Impregnated HydrocolloidDressing

[0164] A 49 year old white male experienced occasional acne vulgaris. Hehad painful, raised, red papules and pustules on his shoulders. Thepatient was treated with a thin hydrocolloid dressing (Craig MedicalProducts Ltd., Clay Gate House 46 Albert Rd. North Reigate, Surrey,United Kingdom) which was impregnated with 1% nanocrystalline silverpowder formed with atomic disorder as in Example 3. Following cleansing,the pustule was covered with a small disc of the dressing, whichremained in place for 24 hours. Upon removal, the pustule was no longerpainful, red, or raised.

Example 9 Treatment of Eczema

[0165] A twenty-nine year old white female presented withacrodermatitis. The erythematous area was located on the dorsal surfaceof the first web space of the left hand. It was bounded by themetacarpal bones of the thumb and index finger. The patient alsocomplained of pruritus associated with the dermatitis. A gel consistingof 0.1% nanocrystalline silver powder (formed with atomic disorder as inExample 3) and 2% carboxymethylcellulose was applied to the inflamedarea before bedtime. There was an immediate antipruritic effect thatprovided the patient with relief in the short term. The next morning allevidence of acrodermatitis (i.e. redness disappeared) was gone. Thecondition had not returned after two weeks.

Example 10 Allergic Contact Dermatitis

[0166] Skin allergic contact hypersensitivity is caused by excessiveinfiltration of eosinophils. An animal model may be used for in vivoevaluation of eosinophil infiltration in the contact sensitivityreaction and to determine whether it is associated with allergic skinconditions such as contact dermatitis. On a gross histology level, thiscan be measured by the degree of erythema and edema at the dermatitissite. Current drugs used for treatment of this and other related eczemaconditions include high potency steroids (Ultravate™), medium potencysteroids (Elocon™) and non steroidal anti-inflammatory compounds(Protopic™ or tacrolimus). These compounds do not always work and mayhave undesirable side effects. Several commercially availableanti-inflammatory products were compared to a nanocrystalline silverpowder for the treatment of allergic contact dermatitis as follows.

[0167] Four healthy domestic pigs (approximate weight 20 kg) were usedin the study. All pigs had normal skin prior to induction of eczema with10% 2,4-dinitrochlorobenzene (DNCB) in acetone. The animals were housedin appropriate animal facilities with 12 hour light-dark cycles. Thepigs were fed antibiotic-free feed and water ad libitum. The pigs werehoused and cared for in accordance with Canadian Council of Animal Careguidelines. On day 0, the hair on both left and right back and side wereclipped. The DNCB solution was painted over this area. This was repeatedon day 7 and 11. On day 11, the solution was painted approximately 4hours before treatment was initiated.

[0168] Treatment groups are shown in the following table. Protopic™(tacrolimus), Elocon™ and Ultravate™ were purchased as creams from thelocal pharmacy. The nanocrystalline silver powder (1 g/L) was mixed intoa 2% sodium carboxymethyl cellulose (CMC) and water solution at 30° C.using a magnetic stirrer at a high speed (Vista Scientific). Petrolatum,commercially known as Vaseline™, was used as a control for Elocon™ andUltravate™. Day of Pig# Treatment (Left Side) Control (Right Side)Treatment 1 Protopic ™ (tacrolimus) Protopic ™ Control Day 0 2 MediumPotency Steroid Petrolatum Day 0 (Elocon ™) 3 2% CMC + 1% 2% CMC Day 0nanocrystalline silver (Vista Scientific) 4 High Potency SteroidPetrolatum Day 0 (Ultravate ™)

[0169] Pigs were placed under general anesthetic with ketamine(Ketalean™, MTC Pharmaceuticals, Cambridge, ON; 4-500 mg) and halothane(MTC Pharmaceuticals). The skin was wiped with a moist gauze and allowedto dry. Bandages (n=8) containing each treatment were applied to theleft side of the thoracolumbar area of the pig, while control bandages(n=8) were applied to the right side of the thoracolumbar area of thepig. Following placement of bandages, they were covered with Tegaderm™(3M Corp., Minneapolis, Minn.) which was secured with an Elastoplast™(Smith and Nephew, Lachine, QC) wrap. Bandages with active agents werechanged daily. The skin associated with each bandage site was scored forseverity of erythema (0=normal, 1=slight, 2=moderate, 3=severe, 4=verysevere) and swelling (0=normal, 1=slight, 2=moderate, 3=severe, 4=verysevere). This was performed on days 0, 1, 2 and 3.

[0170] All pigs remained healthy during the study. Results are shown inthe following tables, and indicated in FIGS. 3 and 4. FIGS. 3 and 4 showthe efficacy of the nanocrystalline silver powder compared to Protopic™,Elocon™ and Ultravate™ in the treatment of contact dermatitis in the pigmodel. Day 0 Day 1 Day 2 Day 3 Treatment (Erythema) Nanocrystallinesilver 3 2 1 0 Protopic ™ 3 3 1.9 0.4 Elocon ™ 3 2.4 2.6 2.6 Ultravate ™3 3 3 3 Treatment (Edema) Nanocrystalline silver 2 1 0 0 Protopic ™ 2 22 0 Elocon ™ 2 2 2 0 Ultravate ™ 2 2 1 0

[0171] The pigs treated with the high (Ultravate™) and medium (Elocon™)strength steroids showed little to no improvement in the degree oferythema associated with contact dermatitis. They did, however, improvein terms of edema in that at Day 3, no swelling was apparent. Protopic™showed a marked improvement when compared to the steroids in both thedegree of erythema and edema. The largest improvement occurred with thenanocrystalline silver powder suspended in a 2% carboxymethyl cellulosegel. Both erythema and edema scores were lower after a single treatmentand were normal after Day 2 (edema) and Day 3 (erythema) of treatment.Clearly the nanocrystalline silver product was more efficacious intreating contact dermatitis than the commercially available products.

Example 11 Preparation of Gels

[0172] No. 1

[0173] A commercial carboxymethyl cellulose/pectin gel (DuoDERM™,ConvaTec Canada, 555, Dr. Frederik Philips, Suite 110, St-Laurent,Quebec, H4M 2×4) was combined with nanocrystalline silver powderprepared as set forth in Example 3 to produce a gel with 0.1% silver. Alogarithmic reduction test was performed as follows in the gel usingPseudomonas aeruginosa. The inoculum was prepared by placing 1bacteriologic loopful of the organism in 5 mL of trypticase soy brothand incubating it for 3-4 h. The inoculum (0.1 mL) was then added to 0.1mL of gel and vortexed (triplicate samples). The mixture was incubatedfor one-half hour. Then 1.8 mL of sodium thioglycollate-saline (STS)solution was added to the test tube and vortexed. Serial dilutions wereprepared on 10⁻to 10⁻⁷. A 0.1 mL aliquot of each dilution was plated induplicate into Petri plates containing Mueller-Hinton agar. The plateswere incubated for 48 h and then colonies were counted. Survivingmembers of organisms were determined and the logarithmic reductioncompared to the initial inoculum was calculated. The logarithmicreduction for this mixture was 6.2, indicating a significantbactericidal effect.

[0174] No. 2

[0175] Carboxymethyl cellulose (CMC) fibers were coated directly toproduce an atomic disordered nanocrystalline silver coating, usingmagnetron sputtering conditions similar to those set forth in Example 1.The CMC was then gelled in water by adding 2.9 g to 100 mL volume. Thismaterial was tested using the method of No. 1. The material generated a5.2 logarithmic reduction of Pseudomonas aeruginosa, demonstrating thatthe gel had a significant bactericidal effect.

[0176] No. 3

[0177] An alginate fibrous substrate was directly coated with an atomicdisordered nanocrystalline silver coating using magnetron sputteringconditions similar to those set forth in Example 1. The alginate (5.7 g)was added to 100 mL volume of water to create a gel. This material wastested using the method of No. 1. The material generated a 5.2logarithmic reduction of Pseudomonas aeruginosa, demonstrating that thegel had a significant bactericidal effect.

[0178] No. 4

[0179] A commercial gel containing CMC and alginate (Purilin gel,Coloplast) was mixed with a atomic disordered nanocrystalline silverpowder to give a product with 0.1% silver. This was tested as above withboth Pseudomonas aeruginosa and Staphylococcus aureus. Zone ofinhibition data was also generated for this gel as follows. An inoculum(Pseudomonas aeruginosa and Staphylococcus aureus) was prepared as inNo. 1 and 0.1 mL of this was spread onto the surface of Mueller-Hintonagar in a Petri dish. A six mm hole was then cut into the agar at thecenter of the Petri dish and removed. The well was filled with either0.1 mL of the silver containing gel, a mupirocin containing cream or amupirocin containing ointment. The Petri plates were then incubated for24 h and the diameter of the zone of inhibition was measured andrecorded.

[0180] The silver containing gel produced 9 mm zone of inhibitionagainst both Pseudomonas aeruginosa and Staphylococcus aureus, while themupirocin cream and ointment produced 42 and 48 mm zones againstStaphylococcus aureus and 0 mm zones against Pseudomonas aeruginosa.

[0181] The silver containing gel reduced the Pseudomonas aeruginosa andStaphylococcus aureus properties by 4.4 and 0.6 log reductions,respectively, showing good bactericidal activity. The mupirocin creamand ointment generated 0.4 and 0.8, and 0.8 and 1.6, log reductionsagainst Staphylococcus aureus and Pseudomonas aeruginosa, respectively.The silver gel had both a greater bactericidal effect and spectrum ofactivity than the mupirocin containing products.

[0182] Nos. 5-10

[0183] The formula for Nos. 5-10 are summarized in the following table.Zones of inhibitions were determined as in No. 4 and log reductions weredetermined as in No. 1.

[0184] All formulae provided a broader spectrum of activity and agreater bactericidal effect than did mupirocin in a cream or ointmentform. The mupirocin cream produced zones of inhibition of 42 and 0, andlog reduction of 0.4 and 0.8, against Staphylococcus aureus andPseudomonas aeruginosa, respectively. Ag Log Log CMC PVA Powder Beta-Methyl Propyl CZOI S. CZOI P. red'n S. red'n P. # (%) (%) (%) glucanparaben paraben aureus aeruginosa aureus aeruginosa 5 2 0.1 11 13 1.4 >66 2 0.5 0.1 0.1 0.02 14 15 3.3 >6 7 2 0.5 0.1 13 14 2 N/A 8 2 0.5 0.10.1 14 14 2 N/A 9 2 0.5 0.1 0.20 14 14 2 N/A 10 2 0.5 0.1 0.5 0.1 0.2014 14 2 >6

[0185] No. 11

[0186] A commercially available gel (glyceryl polymethacrylate) wasblended with nanocrystalline silver powder to produce a gel with asilver content of 0.1%. This gel was tested as in Nos. 5-10 and wasfound to produce zones of 15 mm against both Staphylococcus aureus andPseudomonas aeruginosa. Log reductions of 1.7 and >5 were producedagainst Staphylococcus aureus and Pseudomonas aeruginosa. This gelproduct had a greater spectrum of activity than did mupirocin cream orointment.

Example 12 Treatment of Adult Acne with Nanocrystalline Silver GelOccluded by a Hydrocolloid Dressing

[0187] A 49 year old white male experienced occasional acne vulgaris. Hehad painful, raised, red papules and pustules on his shoulders. Thepatient was treated with gel formulation No. 5 as set forth in Example11. Gel formulation No. 5 was applied to the problem area of thepatient's shoulders and then occluded by a thin hydrocolloid dressing(Craig Medical Products Ltd., Clay Gate House 46 Albert Rd. NorthReigate, Surrey, United Kingdom). The dressing remained in place for 24hours. Upon removal the pustule was no longer painful, red, or raised.

[0188] Treatment of Mucosal or Serosal Conditions

Example 1 Preparation of Nanocrystalline Silver Coatings on Dressings

[0189] This example shows the preparation of a bilayer nanocrystallinesilver coating on a dressing material. A high density polyethylenedressing, DELNET™ or CONFORMANT 2 was coated with a silver base layerand a silver/oxide top layer to generate a coloured antimicrobialcoating having indicator value as described in Example 1 of theTreatment of Hyperproliferative Skin conditions examples. The coatinglayers were formed by magnetron sputtering under the conditions set outin the following table.

Example 2 Preparation of Atomic Disordered Nanocrystalline SilverPowders

[0190] Atomically disordered, nanocrystalline silver powder was preparedas described in Example 3 in the Treatment of Inflammatory Skinconditions examples above.

Example 3

[0191] Silver solutions were prepared by immersing AgHDPE mesh fromdressings prepared as in Example 1 in reverse osmosis water that hadbeen pretreated with CO₂ in order to reduce the pH. Two differentconcentrations of silver solutions were prepared by this method, theconcentrations being 85 μg/ml, and 318 μg/ml. Solutions of silvernitrate were also prepared to use as comparisons in the experiments. Theconcentrations of the silver nitrate were 103 ppm of silver and 295 ppmof silver as determined by Atomic Absorption Spectroscopy.

[0192] The solutions were in turn placed in an ultrasonic nebulizer thatcreated small droplets containing dissolved and suspended parts of thesilver solution. The output from the nebulizer was directed into achamber made from a stainless steel frame and base. Petri dishescontaining Mueller Hinton agar streaked with 4 h old cultures ofPseudomonas aeruginosa and Staphylococcus aureus, were exposed to thesilver solution aerosols and the silver nitrate aerosols.

[0193] The results of the tests show that silver aerosols of thisinvention transmit the antimicrobial activity of the dressings to remotesites, and such aerosols are more effective than comparableconcentrations of silver nitrate.

[0194] In many instances the delivery of antimicrobial materials maymost expeditiously be accomplished by using aerosols (e.g. treatment ofpneumonia). The drawback of aerosols is the requirement for a highconcentration of the active ingredient to ensure that a sufficientamount is delivered to achieve the biological effect desired withoutcausing problems with the carrier solvent (e.g. water). It is preferablythat the equipment for producing an aerosol that contains the dissolvedand suspended components of nanocrystalline silver form droplets ofaerosol direct from the liquid form, and the aerosol droplets must besmall enough to reach the lungs. This means the droplets should be lessthan approximately 10 μm. To meet these requirements the aerosol is notcreated by first evaporating the liquid then condensing it to formdroplets. Rather, aerosols are generated by 1) mechanical disruption ofthe liquid, or 2) air under pressure passing through some form oforifice that combines the air and the liquid in a way that createsdroplets instead of evaporating the liquid.

[0195] Several experiments were carried out with silver solutions ofthis invention and silver nitrate solutions to determine if theantimicrobial activity of the dressing could be transferred through adirect droplet aerosol to a Petri dish.

[0196] a) Methods

[0197] i) Equipment

[0198] The method used for the current tests was the mechanical methodin the form of an ultrasonic nebulizer. For convenience an ultrasonichumidifier was used. The liquid containing the dissolved and suspendedsilver from the dressing of Example 1 was placed in the water reservoirof the humidifier. When power was applied to the humidifier aerosoldroplets of dissolved and suspended silver were generated and flowedfrom the output nozzle.

[0199] A test chamber was constructed using a stainless steel frame witha transparent plastic covering. The frame was placed on a stainlesssteel base plate. The output nozzle from the humidifier was modified sothat the aerosol could be directed into the chamber at a height ofapproximately 30 cm from the base. The plates and other test sampleswere placed on the stainless steel plate and exposed to the aerosol fora prescribed length of time.

[0200] ii) Solutions

[0201] Solution 1—A silver containing solution was prepared by immersing518 sq. inches of the dressing from Example 1 in 1 L of reverse osmosiswater, which was treated with CO₂ to maintain a pH of 6.5. After 20minutes the concentration of silver in the water was 85 μg/ml.

[0202] Solution 2—A solution containing 370 μg/ml of silver from adressing from Example 1 was prepared as follows: 1 L of reverse osmosiswater was purged with commercial grade carbon dioxide until the pH was4.3.

[0203] Sufficient dressing was added to bring the pH up to 6.5. At thattime, the silver concentration was 370 μg/ml.

[0204] Solution 3—Ag as AgNO₃ was prepared by dissolving 0.157 g ofAgNO₃ into 1 L of reverse osmosis water and mixed until dissolved. Thesolution was analyzed by Atomic Absorption Spectroscopy and found to be102.9 ppm of silver.

[0205] Solution 4—Ag as AgNO₃ was prepared by dissolving 0.427 g ofAgNO₃ into 1 L of reverse osmosis water and mixed until dissolved. Thesolution was analyzed by Atomic Absorption Spectroscopy and found to be295 ppm of silver.

[0206] iii) Aerosolization

[0207] Petri dishes, containing Mueller Hinton agar, were streaked with4 h old cultures of Pseudomonas aeruginosa or Staphylococcus aureus. Theplates were then weighed and their exposed outer surfaces were coatedwith Parafilm to prevent condensation from occurring on these surfaces.These plates were placed in the aerosol chamber uncovered. Theultrasonic nebulizer was then started and run for 53 minutes. The plateswere then removed from the chamber, the plastic was removed and thedishes re-weighed so that the amount of moisture loss/gain could bedetermined.

[0208] The plates were then placed in a 35° C. incubator for 16 h. Afterincubation the pattern and amount of growth was assessed on the platesfor both organisms.

[0209] iv) Viability Assessment

[0210] Three of the six plates made for each organism were tested todetermine if the antimicrobial effect was cidal or static in nature.This was accomplished by rinsing or placing a piece of the clear sectionof agar in the Petri dish plates into Tryptic soy broth in a test tubeand incubating for 4 h or 16 h. If the medium turned turbid in 4 h itwould indicate that the antimicrobial affect was bacteriostatic innature. If the organisms took more than 16 h to grow, as indicated byturbidity, it was considered an indication that both static and cidaleffects occurred. If no growth occurred the effect was bactericidal.

[0211] v) Results—The results are summarized in the following table.Solutions 1 and 3 Silver from Dressing AgNO₃ P. S. P. S. Organismaeruginosa aureus aeruginosa aureus Ag concentration 85 85 99 99 (μg/ml)pH of test solution 6.5 6.5 About 6.5 about 6.5 Exposure Time 53 53 5353 (minutes) Exposed are (sq. in.) 9.8 9.8 9.8 9.8 Exp 0.8 0.8 1.05 1.05Weight Gain (g) Growth at 16 h 0 0 0 0 (0-++++) at 48 h 0 ++ 0 ++++Viable 4 h No No No No 16 h No No No N/A

[0212] Solutions 2 and 4 Silver from Dressing AgNO₃ P. S. P. S. Organismaeruginosa aureus aeruginosa aureus Ag concentration 370 370 300 300(μg/ml) pH of test solution 6.5 6.5 About 6.3 about 6.3 Exposure Time 5353 53 53 (minutes) Exposed are (sq. in.) 9.8 9.8 9.8 9.8 Exp 1.14 1.141.12 1.12 Weight Gain (g) Growth at 16 h 0 0 0 0 (0-++++) at 48 h 0 0 0+++ Viable 4 h No No No No 16 h No No No N/A

[0213] vi) Discussion

[0214] At the low concentration of silver in solution, the dressinggenerated silver was effective in controlling the growth of bothorganisms while the silver nitrate only prevented the growth of P.aeruginosa. Viability tests showed that at the low concentration,neither form of silver was completely bacteriocidal although the poorgrowth on the dressing aerosol treated plates compared to the silvernitrate treated plates suggests that a significant log reductionoccurred in the dressing aerosol treated plates.

[0215] At a higher concentration of silver, both dressing generatedsilver (370 μg/ml) and AgNO₃ (300 μg/ml) were effective at controllingP. aeruginosa. Since no re-growth occurred, it is assumed that the agentat this concentration were bactericidal. Silver generated from thedressing was more effective than AgNO₃ at controlling S. aureus. Nore-growth occurred on any plates or in the broth indicating a total killof the organism while in the AgNO₃ treatment, a large number oforganisms grew at 16 h.

[0216] Based on weight gain during aerosol treatments a dose per unitarea can be calculated. In each case for solution 1 the dose was 8.5μg/sq. inch while for solution 2 the dose was 38 μg/sq. inch. Thesedoses, on a per lung basis, would be less than 10 mg of silver per hourof treatment. Each hour of treatment with dressing generated silveraerosols appears to provide at least 48 h of protection. Therefore thedose per day, from the high concentration treatment, would be about 5 mgor a little less than the silver released by 2 sq. inches of SSD perday.

[0217] A most significant advantage of using dressing generated silvermay be the lack of a toxic cation such as NO₃ or sulfadiazine.

[0218] Overall, the example demonstrated that the dressing generatedaerosols are operative to transmit the antimicrobial activity of thedressings to remote sites. Furthermore, the dressing generated aerosolswere more effective than comparable concentrations of silver nitrate.

Example 4 Aerosolized Silver Solutions in Rats

[0219] a) Materials And Methods

[0220] i) Solutions From Atomically Disordered Silver Dressings

[0221] A solution was prepared by sparging CO₂ through 400 ml of reverseosmosis water for 30 minutes at a flow rate of 1 L/min. The beaker ofwater was covered with a piece of parafilm to assist in maintaining asaturated CO₂ environment. This process resulted in the pH of the waterdropping to about 4. At this point, approximately 600 square inches ofsilver-coated net (AgHDPE) prepared as in Example 1 was added to thewater and stirred for approximately 40 minutes resulting in an elevationof the pH to approximately 6.5. The solution was then transferred to amedical nebulizer and connected to an oxygen cylinder with a flow rateof 10 L/min. The outflow of the nebulizer was connected to a sealedanimal chamber housing the rats to be dosed. Only the “test” rats (15randomly assigned animals) received the dosing. The rats received two,one-hour aerosol administrations of the solution on the day ofinfection. Thereafter, the test rats were dosed three times per day foran additional three days.

[0222] ii) Animals

[0223] Thirty male Sprague-Dawley rats were obtained from the Universityof Calgary, Alberta, Canada breeding colony. These animals werespecific-pathogen free and weighed approximately 300 g. The animals werehoused in groups of 5 in plastic cages with wire mesh tops. The rats hadaccess to fresh water and rat chow ad libitum. All animals weremaintained in an appropriate facility with 12-hour light/dark cycles andconstant temperature and humidity, according to facility standardoperating procedures. The protocol was approved by the University ofCalgary Animal Care Committee and was conducted in accordance withguidelines established by the Canadian Council on Animal Care.

[0224] iii) Bacteria

[0225] The bacteria used for infection of these animals were Pseudomonasaeruginosa strain 579. The dose was previously titrated to ascertainthat a dose of up to 10¹⁰ CFU was not lethal for the animals. Thebacteria were grown overnight in Tryptic soy broth, washed once insterile PBS, and re-suspended in a {fraction (1/10)} volume of sterilePBS.

[0226] iv) Infection

[0227] The rats were anesthetized by inhalation of 2% halothane. A 50microliter volume of bacterial suspension was intratracheallyadministered into the bronchi of each rat. This was performednon-surgically on intubated animals. The infection process resulted inthe instillation of approximately 2×10⁹ CFU into the lungs of eachanimal.

[0228] v) Sampling

[0229] On each day, a number of animals were sacrificed. The lungs ofthe animals were aseptically removed, homogenized, and plated todetermine bacterial levels. A few animals were also subjected tobronchoalveolar lavage prior to removal of the lungs. In several cases,lung homogenates and/or lavage fluids were reserved for silver analysis.

[0230] After the first batch of the silver solution was prepared, totalsilver analysis indicated that there was about 225 ppm of total silverin the solution. The solution was reserved for several hours until afternext dosing of the animals. A second silver analysis indicated that thetotal silver in solution had dropped to about 166 ppm. The reason forthe drop was immediately apparent as the silver had visibly precipitatedout of solution and had deposited on the surface of the nebulizer. Oneother batch of freshly prepared solution had a total silverconcentration of 337 ppm. Regardless of the actual numbers, the processof generating the silver solution results in a significant quantity ofsilver in the solution that is aerosolized into the dosing chamber.

[0231] The dosing chamber is not perfect. Although significant amountsof mist are generated into the chamber, the rates tend to lie on top ofone another and are probably exposed to vastly different levels of thesilver mist.

[0232] vi) Results i) Pulmonary Bacterial Levels Day Log CFU/Test LungLog CFU/Control Lung 1 6.2 7.3 2 4.1 7.8 3 0 6.2 4 3.5 4.8

[0233] The bacteriological results gathered from the lungs of thetreated and control animals demonstrated a sharper decline in thenumbers of bacteria present in the lungs following treatment with silvermist as compared to controls. The results indicated that, in spite ofthe small sample sizes and inconsistent exposures, a difference couldstill be noted. There was considerable variation in the numbers ofbacteria recovered from individual animals within each treatment groupand, therefore, there was no significant difference in the results.Gross examination of excised lungs suggested that there may have beenless apparent damage to the lungs in the animals treated with the silvermist as compared to the untreated, infected animal. This was veryencouraging given the potential anti-inflammatory effects of thenanocrystalline silver technology. ii) Pulmonary Silver Levels SacrificeDate Rat Description Total Silver Level Average 36999 Silver mist 1 0.50ppm 36999 Silver mist 2 1.13 ppm 0.74 ppm 36999 Silver mist 3 0.58 ppm37000 Silver mist 4 0.73 ppm 37000 Silver mist 5 0.70 ppm 0.72 ppm 37000Control 1 0.08 ppm 37000 Control 2 0.10 ppm 0.09 ppm

[0234] The results of the silver analysis appear to indicate that theamount of silver in the lung either plateaus or each dose of silver mistdeposits a certain amount of silver within the lung and this level issignificantly diminished prior to the next dosing of the animals.

[0235] The results of this experiment indicated that the method employedto prepare the silver mist solution was reasonably reproducible andyielded relatively high concentrations of silver in solution. However,the silver was prone to precipitation and should be freshly preparedprior to each dosing period. A lengthy period between preparation anddosing, although resulting in a decrease in the amount of silver insolution, did not result in a complete elimination of the silver fromthe solution or even result in the silver concentration dropping to verylow levels.

[0236] The method employed for exposing the rats to the mist is alsoprone to significant variation due to the piling up of the rats and theresultant inconsistent exposure to the silver-containing mist. However,the silver analyses suggested that a reasonably uniform dose of silverwas achieved when only a few animals were present within the dosingchamber.

[0237] Regardless of the difficulties associated with the experiment,the results were indicative of a therapeutic modality for pulmonaryinfections. The results showed that the presence of silver mist waseffective in more rapidly clearing the bacterial load of the infectedlungs than is the host immune system alone. The apparently less severepathology associated with the rat lungs treated with the silver mistshowed that the treatment was effective for more than simply assistingin the killing of invading organisms.

Example 5 Pulmonary Anti-inflammatory Activity

[0238] A solution form nanocrystalline silver coated dressings (AgHDPE)from Example 1 was prepared by sparging CO₂ through 1000 ml of reverseosmosis water using commercial CO₂ Soda Syphon Charger. This processresulted in the pH of the water dropping to about 4. At this point,approximately 333 ml of the carbonated water was decanted into a plasticbottle and 333 square inches of nanocrystalline silver-coated net wasadded to the water. The nanocrystalline silver-coated net and water wereplaced in 37° C. shaker incubator and shaken at 180 RPM for 30 minutesto elevate the pH to approximately 5.8. The solution was thentransferred to a beaker and stirred vigorously for 2 minutes to raisethe pH to approximately at 7.3. The dissolution solution was transferredto a commercial nebulizer which was connected to a medical air cylinderwith a flow rate of approx. 20 L/min. The outflow of the nebulizer wasconnected to a animal chamber housing the rats to be dosed. Only the“test” rats (12 randomly assigned animals) received the dosing. The ratsreceived two—½ hour aerosol administrations of the test solution on theday of infection. Thereafter, the test rats were dosed 3 times per dayfor an additional one and a half days.

[0239] Thirty male Spragu-Dawley rats were obtained. These animals arespecific-pathogen free and weighed approximately 400 g. The animals arehoused in groups of four in plastic cages with wire mesh tops. The ratshad access to fresh water and rat chow ad libitum. All animals weremaintained in an appropriate facility standard operating procedures.

[0240] The bacteria used for infection of these animals were Pseudomonasaeruginosa strain 5588. The dose was previously titrated to ascertainthat a dose of up to 10⁹ CFU was not lethal for the animals. Thebacteria were grown overnight in Tryptic soy broth, washed once insterile PBS and resuspend in sterile PBS. The final concentration of theinoculum was 4×10⁹ CFU/ml.

[0241] The rats were anesthetized by inhalation of 2% halothane. A 400microliter volume of bacterial suspension was intratracheallyadministered in the bronchi of each rat. This was performednon-surgically on intubated animals. The infection process resulted inthe instillation of approximately 10⁹ CFU into the lungs of each animal.

[0242] The three treatment groups of rats and treatment schedules wereas follows:

[0243] Group 1 Infected, not treated (12 Rats)

[0244] Group 2 Infected, animal will be treated by intramuscularlyinjection of Tobramycin at 30 mg/kg (12 mg/rat) once daily (12 Rats)

[0245] Group 3 Infected and treated, using nanocrystalline silversolution and nebulizer (Nebulized Ag), three times a day (12 Rats)

[0246] Day One

[0247] 10:00 AM Infection

[0248] 4:00 PM First treatment (For Group 2, Nebulized Ag for Group 3)

[0249] 8:00 PM Nebulized Ag treatment for Group 3

[0250] Day Two

[0251] 9:00 AM Injection treatment for Group 2, Nebulized Ag for Group 3

[0252] 1:00 PM Sacrifice and sample six Rats in each group

[0253] 3:00 PM Nebulized Ag treatment for Group 3

[0254] 8:00 PM Nebulized Ag treatment for Group 3

[0255] Day Three

[0256] 9:00 AM Injection treatment for Group 2, Nebulized Ag for Group 3

[0257] 1:00 PM Sacrifice and sample six Rats in each group

[0258] On each day, six rats of each group of animals were sacrificed.The lungs of the animals were aseptically removed, homogenized andplated to determine bacterial levels. Lung samples were collected forhistological examination. Three lung homogenates were reserved forsilver analysis. Lungs were grossly scored (absent=0, mild=1, moderate2, and severe=3) based on the degree and involvement of consolidation,hemorrhage, edema and necrosis based upon gross observation.

[0259] Histopathology was scored (0-4) based upon the degree ofconsolidation and inflammation (neutrophil infiltration). The entireright middle lobes of all rats were collected for histopathology. Aswhole lobes were selected there was no bias toward any sample. Allsamples were fixed in neutral buffered formalin at the time the lung wasremoved from the thorax. It was fixed overnight, dehydrated and embeddedin was. Sections were obtained which were hydrated and stained withhaematoxylin and eosin.

[0260] All sections were examined by a veterinary pathologist who wasblinded to the treatment groups, until after the samples were scored andcomments were provided: The Scores and comments are provided in Table 5.(0=normal, 1=slight, 2 moderate, 3 severe, 4 very severe).

[0261] Tissue Colony Counts:

[0262] At 24 hours, there was not a significant reduction in the numberof colony forming units (cfu) in the nebulized Ag group compared to thecontrol but at 48 hours there was a significant reduction in thebacterial numbers in the nebulized Ag animals. The Tobramycin treatedanimals had a similar cfu counts to the controls at time 24 hours and 48hours. Control Tobramycin Nebulization 24 h animal 1 0 2 1 2 0 3 1 3 3 10 4 3 3 0 5 2 2 3 6 3 2 1 48 h animal 7 2 1 1 8 1 2 1 9 1 1 0 10 1 1 011 3 1 1 12 Dead Dead Dead

[0263] Histopathology of Lung Samples:

[0264] Both the control and the Tobramycin treated rats had similarpathology. These are outlined in Table 6. At 24 and 48 hours severeinfiltration of polymorphonuclear leukocytes (PMN's) into theinterstitial spaces of the lung was observed. These cellular elementscould also be identified in alveolar and bronchiolar spaces but to alesser extent. The pulmonary vessels were dilated and the alveolarspaces were filled with proteinaceous material. The silver-nebulizedrats had occasional infiltration of PMN's and no evidence ofaccumulation of fluids in alveolar or bronchiolar spaces. Histopathologyof Lung Samples Removed from Rats Inflam Consol Treatment Time ScoreScore Comments Control (1) 24 3 3 Severe infiltration of PMN intointerstitial spaces. Proteinaceous secretion in alveolar spaces.Occasional PMN in alveolar and bronchiolar space. Consolidation inaffected areas. Involvement of 70% of sample. Interstitial Pneumonia.Control (2) 24 3 3 Severe infiltration of PMNs into interstitial spaces.Proteinaceous secretion in alveolar spaces. Occasional PMN in alveolarand bronchiolar space. Consolidation in affected areas. Involvement of80% of sample. Interstitial Pneumonia Tobramycin (1) 24 3 3 Severeinfiltration of PMNs into interstitial spaces. Proteinaceous secretionin alveolar spaces. Occasional PMN in alveolar and bronchiolar space.Consolidation in affected areas. Involvement of 90% of sample.Interstitial Pneumonia. Tobramycin (2) 24 3 3 Severe infiltration ofPMNs into interstitial spaces. Proteinaceous secretion in alveolarspaces. Occasional PMN in alveolar and bronchiolar space. Consolidationin affected areas. Involvement of 80% of sample. Interstitial Pneumonia.Nebulized Ag (1) 24 0 1 No PMNs in area. Slight consolidation. NormalLung Nebulized Ag (2) 24 1 1 Slight infiltration of PMNs around vesselsand brocheoli. Control (1) 48 3 3 Severe infiltration of PMNs intointerstitial spaces. Proteinaceous secretion in alveolar spaces.Occasional PMN in alveolar and bronchiolar space. Consolidation inaffected areas. Involvement of 80% of sample. Interstitial Pneumonia.Control (2) 48 2 2 Severe infiltration of PMNs into interstitial spaces.Proteinaceous secretion in alveolar spaces. Occasional PMN in alveolarand bronchiolar space. Consolidation in affected areas. Involvement of60% of sample. Interstitial Pneumonia. Tobramycin (1) 48 3 3 Severeinfiltration of PMNs into interstitial spaces. Proteinaceous secretionin alveolar spaces. Occasional PMN in alveolar and bronchiolar space.Consolidation in affected areas. Involvement of 70% of sample.Interstitial Pneumonia. Tobramycin (2) 48 3 3 Severe infiltration ofPMNs into interstitial spaces. Proteinaceous secretion in alveolarspaces. Occasional PMN in alveolar and bronchiolar space. Consolidationin affected areas. Involvement of 70% of sample. Interstitial Pneumonia.Slight infiltration of PMNs around vessels and brocheoli. Nebulized Ag(1) 48 1 0 Slight infiltration of PMNs around vessels and brocheoli.Nebulized Ag (2) Normal lung.

[0265] The nebulized nanocrystalline silver reduced bacterialcolonization in Pseudomonas infected lungs reduced injury as determinedby gross pathology (consolidation, hemorrhage, edema) in Pseudomonasinfected lungs. Further, the nanocrystalline silver delivered by aerosolreduced pulmonary inflammation (primarily PMN infiltration) inPseudomonas infected lungs compared to Tobramycin (IM).

Example 6 Pulmonary Anti-inflammatory Activity

[0266] A solution was prepared by sparging CO₂ through 1000 ml ofreverse osmosis water using commercial CO₂ Soda Syphon Charger. Thisprocess results in the pH of the water dropping to about 4. At thispoint, approximately 333 ml of the carbonated water was decanted into aplastic bottle and 333 square inches of nanocrystalline silver-coatednet was added to the water. The nanocrystalline silver-coated net andwater were placed in 37° C. shaker incubator and shaken at 180 RPM for30 minutes to elevate the pH to approximately 5.8. The solution was thentransferred to a beaker and stirred vigorously for 2 minutes to raisethe pH to approximately at 7.3. The solution had a final silverconcentration of approximately 400 ppm.

[0267] Test solutions of silver nitrate (400 ppm) and silver acetate(400 ppm) were prepared by dissolving the silver salts in deionizedwater. A colloidal silver solution (20 ppm) in was obtained from acommercial source.

[0268] The dissolution solutions were transferred to commercialnebulizers which were connected to a Medical air cylinder with a flowrate of approx. 20 L/min. The outflows of the nebulizers were connectedto an animal chamber housing the rats to be dosed. All rats (40 randomlyassigned animals) received the dosing. The rats received two—½ houraerosol administrations of the test solutions on the day of infection.Thereafter, the test rats were dosed 3 times per day for an additionalone and a half days.

[0269] Forty male Sprague-Dawley rats were obtained. These animals arespecific-pathogen free and weighed approximately 400 g. The animals werehoused in groups of four in plastic cages with wire mesh tops. The ratshad access to fresh water and rat chow ad libitum. All animals weremaintained in an appropriate facility with 12-hour light/dark cycles andconstant temperature and humidity, according to facility standardoperating procedures.

[0270] The bacteria used for infection of 20 these animals werePseudomonas aeruginosa strain 5588. The dose was previously titrated toascertain that a dose of up to 10⁹ CFU was not lethal for the animals.The bacteria were grown overnight in Tryptic soy broth, washed once insterile PBS and resuspend in sterile PBS. The final concentration of theinoculum was 4×10⁹ CFU/ml.

[0271] The rats were anesthetized by inhalation of 2% halothane. A 400microliter volume of bacterial suspension was intratracheallyadministered into the bronchi of each rat. This was performednon-surgically on intubated animals. The infection process resulted inthe instillation of approximately 10⁹ CFU into the lungs of each animal.

[0272] Group 1 & 2: Not infected and infected, treated with nebulizedsilver nitrate. (10 Rats)

[0273] Group 3 & 4: Not infected and infected, treated with nebulizedcolloidal silver. (10 Rats)

[0274] Group 5 & 6: Not infected and infected, treated with nebulizednanocrystalline silver. (10 Rats)

[0275] Group 7 & 8: Not infected and infected, treated with nebulizedsilver acetate. (10 Rats)

[0276] The treatment schedule was as follows: Day One Day Two 10:00 AMInfection 9:00 AM Third Treatment  4:00 PM First Treatment 1:00 PMSacrifice, sample 5 rats/Gp  8:00 PM Second Treatment

[0277] All rats of each group of animals were sacrificed after 24 h. Thelungs of the animals were aseptically removed, homogenized and plated todetermine bacterial levels. Lung samples were collected for histologicalexamination. Three lung homogenates were reserved for silver analysis.Lungs were grossly scored (absent=0, mild=1, moderate=2, and severe=3)based on the degree of involvement of consolidation, hemorrhage, edemaand necrosis based upon gross observation.

[0278] Histopathology was scored (0-4) based upon the degree ofconsolidation and inflammation (neutrophil infiltration). The entireright middle lobes of all rats were collected for histopahtology. Aswhole lobes were selected there was no bias toward any sample. Allsamples were fixed in neutral buffered formalin at the time the lung wasremoved from the thorax. It was fixed overnight, dehydrated and embeddedin wax. Sections were obtained which were hydrated and stained withhaematoxylin and eosin.

[0279] All sections were examined by a veterinary pathologist who wasblinded to the treatment groups, until after the samples were scored andcomments were provided, with scoring being (0=normal, I=slight,2=moderate, 3=severe, 4=very severe).

[0280] All rats in the silver nitrate, silver acetate and colloidalsilver groups had lung that were grossly scored as moderately toseverely inflamed while the lungs of the nanocrystalline group weregrossly scored as normal to slightly inflamed. This was confirmed by thehistopathological analyses.

[0281] The nanocrystalline derived silver solution had pulmonaryanti-inflammatory properties while the other forms of silver did not.

Example 7 Treatment of an Infected Throat with a Nanocrystalline SilverDerived Solution

[0282] A forty-nine year old male was suffering from an infected throat.The condition was accompanied by fever and a severe pain that madeswallowing very difficult and limited the patients ability to sleep. Asolution of nanocrystalline derived silver was prepared using a methodsimilar to Example 1. This solution was gargled for one minute andrepeated 3 times over the next ten minutes. Within an hour the pain wasreduced to the point where the patient could sleep. The treatment wasrepeated every four hours for 16 h and then once 8 h later. The throatinfection was cleared as determined by the elimination of fever andpain. No further symptoms occurred.

Example 8 Preparation of Gels

[0283] Gels were prepared as described above in Example 11 in theTreatment of Inflammatory Skin Conditions examples above.

[0284] Apoptosis Induction/MMP Modulation

Example 1 Preparation of Nanocrystalline Silver Coatings on Dressings

[0285] This example shows the preparation of a bilayer nanocrystallinesilver coating on a dressing material. A high density polyethylenedressing, DELNET™ or CONFORMANT 2™ was coated with a silver base layerand a silver/oxide top layer to generate a coloured antimicrobialcoating having indicator value as described in Example 1 of theTreatment of Hyperproliferative Skin conditions examples. The coatinglayers were formed by magnetron sputtering under the conditions set outin the following table.

Example 2 Preparation of Atomic Disordered Nanocrystalline SilverPowders

[0286] Atomically disordered, nanocrystalline silver powders wereprepared as described in Example 3 in the Treatment of Inflammatory SkinConditions examples above.

Example 3 Preparation of Gels

[0287] Gels were prepared as described above in Example 11 in theTreatment of Inflammatory Skin Conditions examples above.

Example 4 Effects of Antimicrobial Silver on Apoptosis and MatrixMetalloproteinases in a Porcine Model

[0288] A porcine model was used to examine the effects of anantimicrobial metal formed with atomic disorder, preferably silver, onapoptosis and matrix metalloproteinases. Young, commercially produced,specific pathogen free domestic swine (20-25 kg) were used in thesestudies. The animals were conditioned in an animal facility for one weekprior to any experimental manipulation. Typically, three animals wereused in each experiment. The animals received water and hog ration(Unifeed™, Calgary, Alberta) without antibiotics ad libitum, were housedindividually in suspended stainless steel cages (5′×6′), and maintainedin a controlled environment with 12 hours of light per day. The studywas approved by the University of Calgary Animal Care Committee and wasconducted in accordance with guidelines established by the CanadianCouncil on Animal Care.

[0289] Antimicrobial silver metal was administered in the form of adressing. The dressings included:

[0290] i) AB—nanocrystalline silver-coated dressing (the non-foam,three-layer dressing as set out in Example 1), comprising two layers ofsilver-coated high density polyethylene (HDPE) bonded on either side ofan absorbent rayon/polyester core;

[0291] ii) AgHDPE—nanocrystalline silver coated HDPE layers asepticallyseparated from the absorbent core of the AB dressings;

[0292] iii) Control—identical in construction to the AB dressing exceptthat the HDPE was not coated with nanocrystalline silver;

[0293] iv) Gauze—the absorbent rayon/polyester core of the AB dressings;

[0294] v) cHDPE—the uncoated HDPE aseptically removed from the absorbentcore of the control dressings; and

[0295] vi) SN—sterile piece of the gauze dressing to which 24 μgsilver/square inch (from silver nitrate) was added. This amount ofsilver is equivalent to the amount of silver released from a square inchof the AB dressing immersed in serum over a 24 hour period, asdetermined by atomic absorption analysis.

[0296] Dressings (i)-(iii) were gamma sterilized (25 kGy) prior to use.All dressings were moistened with sterile water prior to application tothe incision. In some cases, the incisions were covered with a layer ofocclusive polyurethane (Tegaderm™, 3M Corp., Minneapolis, Minn.).

[0297] Three isolates of bacteria were used in the inoculum, includingPseudomonas aeruginosa, Fusobacterium sp., and coagulase-negativestaphylococci (CNS) (Culture Collection, University of Calgary, Calgary,Alberta). The bacterial strains were grown under appropriate conditionsovernight prior to the day of surgery. On the morning of surgery, theorganisms were washed with sterile water and resuspended to a finaldensity of approximately 10⁷ CFU/mL. The bacteria were mixed together ina ratio of 1:0.5:1 (Pseudoinonas:CNS:Fusobacterium) in water. Sufficientinoculum was prepared to wet the incision created in each experiment.This procedure resulted in the incisions initially being evenlycontaminated with approximately 8×10⁴ CFU/cm².

[0298] Prior to treatment, animals were sedated by an intramuscularinjection of a mixture of 10 mg/kg ketamine (Ketalean™, MTCPharmaceuticals, Cambridge, ON) and 0.2 mg/kg acepromazine (Atravet™,Ayerst Laboratories), followed by complete anesthesia induced by maskinhalation of 1-2% halothane (MTC Pharmaceuticals). Following inductionof anesthesia, the dorsal and lateral thorax and abdomen of each animalwas clipped using a #40 Osler blade and the skin subsequently scrubbedwith a non-antibiotic soap, and allowed to dry prior to incision.

[0299] Animals typically received 20 full-thickness incisions, 10 oneach side of the dorsal thorax. The incisions were created using a 2 cmdiameter trephine. An epinephrine solution was then applied to theincisions to provide for complete hemostasis prior to inoculation. Theincisions were contaminated by covering them with gauze sponges soakedwith the bacterial inoculum. The wet sponges were covered with anocclusive barrier and allowed to stand for 15 minutes. In someinstances, an incision was then sampled to determine the initialinoculum. Following any requisite sampling, the incisions were dressedwith the appropriate dressings and covered with an occlusive layer thatwas secured with Elastoplast™ tape (Smith & Nephew, Lachine, QC). Allanimals received narcotic pain medication (Torbugesic™, AyerstLaboratories, Montreal, QC, 0.2 mg/kg), as required.

[0300] The experimental and control groups are summarized in thefollowing table: Animal # Left Side (Silver Treatment) Right Side(Controls) Pig 1 silver nitrate (SN) on gauze gauze moistened with waterPig 2 AgHDPE cHDPE Pig 3 AB control

[0301] A 2 cm diameter circle of the appropriate dressing was applied toeach incision. For Pig 1, incisions on the left side were dressed withsilver nitrate-moistened (SN) gauze, while control incisions on theright side received water-moistened gauze dressing. For Pig 2, theincisions on the left side were dressed with silver-coated HDPE(AgHDPE), while the control incisions on the right side receivednon-coated HDPE (cHDPE). For Pig 3, the incisions on the left side weredressed with AB dressing, while incisions on the right side received thevehicle control. For these experiments, each incision was individuallycovered with an occlusive film dressing (Tegaderm™, 3M Corp.,Minneapolis, Minn.).

[0302] Each day following incision (up to 5 days), the dressingmaterials from each of the experimental and control groups werecollected and pooled within each group. These dressing materials werethen placed in conical centrifuge tube containing glass wool. The tubesand contents were centrifuged to remove all liquid from the dressings.The glass wool was then placed into a 5-mL syringe and pressed torecover the incision fluid from each of the six sample sets. Theincisions were rebandaged in an identical manner to the originaldressing format each time. Incision fluid which collected under theocclusive dressing was also aspirated and reserved for analysis. Due tothe small volumes collected from each incision, it was necessary to poolthe collected fluid from each of 10 incisions dressed with the same typeof dressing. All incision fluids were stored at −80° C. until analysis.

[0303] Prior to enzyme zymography or activity assays, the proteinconcentrations of the incision fluid samples were compared to ensurethat the protein levels in each sample were similar. The samples werediluted 1:100 in water and assayed using the BCA Protein Assay System™(Pierce Chemical, Rockford, Ill.). A standard curve was concurrentlyconstructed using dilutions of bovine serum albumin. Incision fluid wasdiluted in water and then mixed with an equal volume of sample buffer(0.06 M Tris HCl, pH 6.8; 12% SDS; 10% glycerol; 0.005% bromophenolblue). The samples were then electrophoresed on 10% polyacrylamide(BioRad, Mississauga, ON) gels containing 0.1% gelatin. The proteinswere then incubated in renaturing buffer (2.5% Triton™ X-100) for 90minutes at 37° C. Following enzyme renaturation, the gels were incubatedovernight in substrate buffer (50 mM Tri-HCl, pH 7.8; 5 mM CaCl₂; 200 mMNaCl; 0.02% Brij-35) with or without 10 mM 1,10 phenanthroline. The gelswere subsequently stained with a standard Coomassie Blue stain anddestained in methanol/acetic acid. Unless otherwise indicated, allchemicals were obtained from Sigma-Aldrich (Oakville, ON).

[0304] The incision fluid samples were assayed for the total amount ofprotein present. These values were between 30-80 mg/mL. The samples fromindividual animals were even more similar, varying by only 10-20 mg/mLin the pooled incision fluid.

[0305] i) Assay for Activity of Total MMPs

[0306] The total MMP activity of the incision fluid samples wasdetermined by incubating diluted incision fluid with a quenchedfluorescein-conjugated substrate (EnzChek DQ gelatin™, Molecular Probes,Eugene, Oreg.) for approximately 20 hours. Following incubation, thesamples were read in a fluorometer (excitation 1=480 nm; emission 1=520nm). Activity was compared to a collagenase standard as well asexperimental versus control incision fluids.

[0307]FIG. 4 shows the change in total MMP activity from differentlytreated incision sites over a five-day period. The silver-coated HDPE(AgHDPE) results were essentially identical to those obtained using thesilver-coated dressing (AB). Similarly, the gauze, non-coated HDPE(cHDPE), and control dressings yielded results essentially identical toeach other and to untreated incisions under occlusion from whichincision fluid was collected. Only the results from the control,silver-coated dressing (AB), silver-coated HDPE (AgHDPE), and silvernitrate moistened gauze (SN) are thus shown. The total MMP activity ofthe incision fluid sample from the control dressing was low for thefirst few days, then rose dramatically and remained high for theduration of the experiment. Similarly, the silver-nitrate moistenedgauze (SN) demonstrated an almost identical pattern of total MMPactivity. Results from the silver-coated dressing (AB) yieldeddramatically different results. The level of MMP activity remainedsteady for the duration of the experiment and did not spike to highlevels. Instead, it remained at a level roughly 60% lower than thehighest level of activity reached in control or silver-nitrate moistenedgauze (SN).

[0308] ii) Assay for Activity of Gelatinases

[0309] Gelatinases include MMP-2 (secreted by fibroblasts and a widevariety of other cell types) and MMP-9 (released by mononuclearphagocytes, neutrophils, corneal epithelial cells, tumor cells,cytotrophoblasts and keratinocytes). The gelatinases degrade gelatins(denatured collagens) and collagen type IV (basement membrane).Zymograms were run to examine changes in the levels and activity ofMMP-9 and MMP-2 over the duration of the experiment.

[0310] Results of the zymograms for the control and silver nitratemoistened gauze (SN) appeared to be identical. The levels of MMP-9declined over the period examined, particularly levels of the activeform of MMP-9. The silver-coated dressing (AB) demonstrated higherlevels of active MMP-9 than for the control. On Day 2, the silver-coateddressing (AB) showed lower levels of active MMP-9 than in the control.On Day 4, the silver-coated dressing (AB) showed little active MMP-9. Inthe control, the amount of the latent enzyme appeared to decrease whilethe active form of MMP-9 increased, particularly up to Day 4.

[0311] There was not much difference in the levels of MMP-2 activity forthe silver-coated dressing (AB) over the duration of the experiment.However, there was an increase in the level of active MMP-2 in thecontrol dressing by Day 5. It was also observed that the levels of someother, unidentified, gelatinolytic enzymes also decreased in thesilver-coated dressing (AB) compared to the control.

[0312] iii) Assay of Total Protease Activity

[0313] Since MMPs have proteolytic activity, the total protease activityin incision fluid samples was assessed by incubating the samples with 3mg/mL azocasein in 0.05 M Tris HCl, pH 7.5 for 24 hours at 37° C. Theundigested substrate was then precipitated by the addition of 20%trichloroacetic acid. The absorbance of the supernatant was thenassessed using a spectrophotometer, 1=400 nm. The absorbance wascompared to a standard curve prepared with bovine pancreatic trypsin.

[0314] Results paralleled those obtained in the total MMP assay above.The incision fluid samples for the control and silver nitrate moistenedgauze (SN) demonstrated a pronounced increase in activity after Day 2(FIG. 5). Incision fluid from the silver nitrate moistened gauze (SN)also demonstrated a marked increase in the total protease activitycompared to control dressing incision fluid (FIG. 4). However, the totalprotease activity in the incision fluids of the silver coated dressings(AB) remained constant over the duration of the experiment.

[0315] Antimicrobial silver was thus demonstrated to be effective inmodulating overall MMP activity. However, silver nitrate was noteffective in modulating MMP activity in spite of the Ag⁺ concentrationbeing approximately the same levels as were expected to be released fromthe silver-coated dressing (AB) over the same period of time (24 h)between applications. The reason for the difference in effects may berelated to the inherent nature of the two silver formulations. In thecase of silver nitrate, although the silver was added to provide asimilar final concentration of Ag⁺ as was anticipated to be releasedfrom the silver-coated dressing (AB), the Ag⁺ ions were added at once.It would thus be expected that the serum proteins and chlorides withinthe incision fluid would quickly inactivate a large portion of the Ag⁺.In the case of the silver-coated dressing (AB), the silver iscontinuously released to maintain a steady-state equilibrium,maintaining an effective level of silver in the incision for a prolongedperiod.

[0316] iv) Apoptosis

[0317] Histological assessment of cell apoptosis was carried out inorder to determine whether the silver-coated dressing (AB) affectedapoptosis within the incision.

[0318] Histological Observations of Porcine Tissue

[0319] Samples of tissue from the incisions were collected daily for theduration of the experiment, except for Day 1, and examined for evidenceof apoptosis. The samples were fixed in 3.7% formaldehyde in PBS for 24hours, then embedded in paraffin, and cut into 5 mm thick sections. Thesamples were then de-waxed with Clearing Solvent™ (Stephan's Scientific,Riverdale, N.J.) and rehydrated through an ethanol:water dilutionseries. The sections were treated with 20 mg/mL proteinase K (Qiagen,Germantown, Md.) in 10 mM Tris-HCl (pH 7.4) for 30 minutes at roomtemperature.

[0320] Terminal deoxynucleotidyl transferase nick end labeling (TUNELstaining) was performed using an In Situ Cell Death Detection POD Kit™(Boehringer Mannheim, Indianapolis, Ind.). Using this technique, cellswhich stain brown are those being eliminated by apoptosis. Endogenousperoxidase was blocked with 3% hydrogen peroxide in methanol for 10minutes at room temperature then cells were permeabilized with 0.1%Triton™ X-100 (in 0.1% sodium citrate) for 2 minutes on ice. Afterpermeabilization, the samples were treated with the terminal transferaseenzyme solution incubated in a humidified chamber at 37° C. for 60minutes. Following labelling, the samples were washed once with 1.0%Triton™ X-100 and twice with PBS. The sections were incubated withConverter-POD™ (Boehringer Mannheim, Indianapolis, Ind.) in a humidifiedchamber at 37° C. for 30 minutes, and repeated washing with 1.0% Triton™X-100 and PBS. Subsequently, the samples were incubated with DABsubstrate (Vector Laboratory Inc., Burlingame, Calif.) for 10 minutes atroom temperature and washed with 1.0% Triton™ X-100 and PBS. It was alsonecessary to counterstain the sections with hematoxylin nuclearcounterstain (Vector Laboratory Inc., Burlingame, Calif.) for 10seconds.

[0321] The prepared samples were then ready to be observed by lightmicroscopy for evidence of apoptosis. For a positive control, thepermeabilized sections were treated with 100 mg/mL DNase I in PBS for 10minutes at room temperature to induce DNA strand breaks. For negativecontrols, the terminal transferase enzyme, POD or DAB were omittedbetween each labelling step.

[0322] In all samples examined, there was little difference between thecontrol and silver nitrate moistened gauze (SN). However, significantapoptosis of the cell population was observed in incisions of thesilver-coated dressing (AB). In the control incision, there weresignificant numbers of polymorphonuclear leukocytes (PMNs) and fewfibroblasts, while in incisions of the silver-coated dressing (AB),there were significantly more fibroblasts and few PMNs.

[0323] Histopathological Scoring of Porcine Tissue

[0324] Animals were anesthetized as described above of Days 1, 4, and 7.A mid-incision biopsy was collected with a sterile 4 mm biopsy punch.The tissue was fixed in 10% neutral buffered formalin, embedded inmethacrylate and sectioned (2-5 mm thick). The sections were stainedwith Lee's methylene blue and basic fuschin to demonstrate the cellularorganization and bacteria. A pathologist blinded to the treatmentsscored the sections based on the presence of fibroblasts, PMNs andbacteria as follows: 0=absent; +=occasional with 1-5 per high powerfield of view; ++=moderate with 6-20 per high power field of view;+++=−abundant with 21-50 per high power field of view; ++++=veryabundant with more than 50 per high power field of view (see thefollowing table). Day Post- Incision Dressing Fibroblasts PMNs Bacteria1 Silver coated ++ ++ + (AB) 1 Control 0 +++ ++++ 4 Silver coated ++++++ 0 (AB) 4 Control + ++++ ++++ 7 Silver Coated ++++ + 0 (AB) 7 Control+++ +++ +++

[0325] The microscopic observation of the biopsy samples revealed thatthe infiltrating cell types were significantly different between thecontrol and silver-coated dressings (AB). The control incisions werecharacterized by a large numbers of PMNs, while the silver-coateddressings (AB) demonstrated a larger proportion of fibroblasts andmonocytes. The relative abundance of the fibroblasts in incisions of thesilver-coated dressings (AB) became increasingly pronounced through toDay 7, as compared to the control incisions that remained populatedlargely by PMNs and monocytes. The staining method enabled staining alsoof bacteria, which was abundant in the control incision but generallyabsent in the incisions of the silver-coated dressings (AB).

[0326] Incisions treated with the nanocrystalline antimicrobial silverthus demonstrated more extensive apoptosis than did cells from incisionstreated with either control or silver nitrate dressings. During thefirst two days following incision, the cell type which demonstrated themost pronounced increase in apoptosis were neutrophils. This suggeststhat part of the reason for the moderated neutrophil presence and theresultant modulation of MMP levels was due to neutrophil apoptosis. Ithas been shown that the number of apoptotic cells increases as theincision closes and that this is part of the mechanism involved in thedecrease in cellularity of the maturing scar tissue (Desmouliere, A.,Badid, C., Bochaton-Piallat, M. and Gabbiani, G. (1997) Apoptosis duringwound healing, fibrocontractive diseases and vascular wall injury. Int.J. Biochem. Cell Biol. 29: 19-30.). The results suggest that thematuring of the nascent dermal and epidermal tissues may also beaccelerated in the presence of the nanocrystalline antimicrobialmetal-containing materials. The findings indicated that acceleration inhealing induced by the nanocrystalline antimicrobial metal-containingmaterials is associated with a reduction of local MMP activity, as wellas with an increased incidence of cell apoptosis within the incision.

Example 5 Clinical Study on the Effect of Silver-Coated Dressings onMMPs and Cytokines

[0327] This study was conducted to assess the effect of thesilver-coated dressing on the concentrations of MMPs and cytokines innon-healing wounds over time during treatment. The modulation of thelevels of active MMPs and cytokines may alleviate the inflammatoryresponse in a wound, allowing the wound to advance through thesubsequent stages of wound healing culminating in a healed wound.

[0328] A total of 10 patients with non-healing venous stasis ulcers wererandomly assigned to treatment with a silver-coated dressing (5patients) or a control dressing (5 patients). The silver-coated dressingwas prepared as in Example 1. The control dressing was identical inconstruction to the silver-coated dressing of Example 1, except that theHDPE was not coated with silver. The ulcers were dressed in appropriatepressure dressings to correct the underlying medical problem. Samples ofthe ulcer fluid were collected before treatment (day 0) and at weeklyintervals (days 1, 7, 14 and 21) by removing the silver-coated dressingor control dressing, and replacing the dressing with Tegaderm™ occlusivedressing (3M Corp., Minneapolis, Minn.) for one hour to allow woundfluids to collect. The fluid samples were aspirated from below thedressing in a syringe, and were frozen at −80° C. until assayed.

[0329] Assays were conducted for active MMP-9, active MMP-2, Tumornecrosis factor-α (TNF-α) and Interleukin-1β (IL-1β). High levels ofMMP-9 and MMP-2 are predominant in non-healing wounds, with levelsdecreasing over time in normal healing wounds. Released by activatedmacrophages, TNF-α and IL-1 β are indicators of wound inflammation.Levels of TNF-α and IL-1β are elevated in non-healing wounds andincrease release of pro-MMPs, for example, MMP-9 and MMP-2.

[0330] To measure the levels of active MMP-9 and MMP-2, enzyme captureassays (BioTrak, N.J.) were conducted. In this method, active enzyme isdetected through activation of a modified pro-detection enzyme and thecleavage of its chromogenic peptide substrate. The resultant color isread by spectrophotometer, and the concentration of MMP is determined byinterpolation of a standard curve, expressed in ng/ml (see results inFIGS. 6 and 7).

[0331] To assay the levels of cytokines, IL-1β levels were measuredusing a sandwich immunoassay (BioTrak, N.J.), while TNF-α levels weremeasured by a high sensitivity sandwich antibody assay (BioTrak, N.J.).In both methods, endogenous cytokine is bound to an immobilized antibodyand then detected by an addition of a biotinylated antibody, followed bya colorimetric substrate. The color is measured by a spectrophotometer,and the concentrations of TNF-α and IL-1β are determined byinterpolation of a standard curve and expressed as pg/ml (see results inFIGS. 8 and 9).

[0332] Total protein levels were measured for each sample to standardizethe measures of the MMPs and cytokines. Total protein levels weremeasured using BCA Protein Assay System™ (Pierce Chemical, Rockford,Ill.). No protein level of any sample was significantly different fromthe total mean.

[0333]FIG. 6 is a graph showing the concentrations (ng/ml) of activeMMP-9 in fluid samples recovered from ulcers dressed with silver-coateddressing (Silver) and control dressing (Control) at days 0, 1, 7, 14 and21. The levels of active MMP-9 decreased to a normal level, and weresuppressed over time with the silver-coated dressing compared to thecontrol dressing, demonstrating a modulating effect of the silver-coateddressing.

[0334]FIG. 7 is a graph showing the concentrations (ng/ml) of activeMMP-2 in fluid samples recovered from ulcers dressed with silver-coateddressing (Silver) and control dressing (Control) at days 0, 1, 7, 14 and21. The levels of active MMP-2 were not significantly different with thesilver-coated dressing and the control dressing.

[0335]FIG. 8 is a graph showing the concentrations (pg/ml) of TNF-α influid samples recovered from ulcers dressed with silver-coated dressing(Silver) and control dressing (Control) at days 0, 1, 7, 14 and 21. Thelevels of TNF-α were suppressed over the treatment period, and did notincrease significantly over the treatment period with the silver-coateddressing, while the levels in the control dressing increased,demonstrating a modulating effect of the silver-coated dressing.

[0336]FIG. 9 is a graph showing the concentrations (pg/ml) of IL-1β influid samples recovered from ulcers dressed with silver-coated dressing(Silver) and control dressing (Control) at days 0, 1, 7, 14 and 21. Thelevels of IL-1β were not significantly different with the silver-coateddressing and the control dressing.

[0337] The study suggests that the modulation of the MMP-9 and TNF-αlevels is responsible for improved wound healing and reducedinflammation with silver-coated dressings. In comparison, the levels ofMMPs and cytokines did not decrease over time with the controldressings.

[0338] This example and Example 4 above, taken together with theevidence that the silver materials herein disclosed are capable ofreducing inflammation (see co-pending U.S. patent application Ser. Nos.10/131,568; 10/131,511; 10/131,509; 10/131,513; and 10/128,208 filedApr. 23, 2002; and co-pending U.S. patent application Ser. No.09/840,637 filed Apr. 23, 2001, and U.S. Provisional Patent ApplicationNo. 60/285,884 filed Apr. 23, 2001) demonstrates a method of reducinginflammation in a patient in need thereof, by contacting an area ofinflammation or an inflammatory cell with a therapeutically effectiveamount of the antimicrobial metal-containing materials in a crystallineform. The antimicrobial metal-containing materials are characterized bysufficient atomic disorder, such that the metal, in contact with analcohol or water-based electrolyte, releases atoms, ions, molecules, orclusters of at least one antimicrobial metal at a concentrationsufficient to modulate the release of one or both of MMP-9 and TNF-α.Excessive TNF production has been reported in diseases, such as cancerand autoimmune diseases, which are characterized by elevated MMPactivity. In this regard, use of the nanocrystalline silver of thepresent invention, when in therapeutically effective amounts, providesthe dual modulation of MMP-9 and TNF-α to alleviate the particularcondition.

ADDITIONAL EXAMPLES Example 1

[0339] 6 milligrams of antimicrobial metal-containing material withatomic disorder, in free-standing powder form, are sprinkled lightlyonto 6.5 cm² of burned tissue, and thereafter wet with a light spray ofwater or wound exudate or TDWL (Trans Dermal Water Loss) or other bodilyfluids, so as to provide an antimicrobial treatment to the burnedtissue. The treatment is repeated every 24 hours until the therapeuticeffects are no longer needed.

Example 2

[0340] 0.5 milligrams of antimicrobial metal-containing material withatomic disorder, in free-standing powder form, are injected, using asmall-needle drug delivery system or a needle-less drug delivery system,into gum tissue so as to treat gingivitis. The treatment is repeatedevery 3 days until the therapeutic effects are no longer needed.

Example 3

[0341] A solution of antimicrobial metal-containing material with atomicdisorder is prepared by dissolving 6 milligrams of antimicrobialmetal-containing material with atomic disorder in 1 gram of water. Thesolution of antimicrobial metal-containing material with atomic disorderis applied as a rinse or bath or wash to a wound site so as to providean antimicrobial treatment to the wound site. The treatment is repeatedevery 24 hours until the therapeutic effects are no longer needed.

Example 4

[0342] A solution of antimicrobial metal-containing material with atomicdisorder is prepared by dissolving 6 milligrams of antimicrobialmetal-containing material with atomic disorder in 1 gram of water. Thesolution of antimicrobial metal-containing material with atomic disorderis applied to the interior of the bladder via a catheter so as toprovide antimicrobial treatment to the bladder. The treatment isrepeated every 8 hours until the therapeutic effects are no longerneeded.

Example 5

[0343] A solution of antimicrobial metal-containing material with atomicdisorder is prepared by dissolving 6 milligrams of antimicrobialmetal-containing material with atomic disorder in 1 gram of water. Thesolution of antimicrobial metal-containing material with atomic disorderis injected (using a small-needle or needle-less injection system) underthe toenails or into the nail bed and/or the surrounding tissue of aperson suffering from onychomycosis so as to provide an antimicrobialtreatment to the tissue. The treatment is repeated 2 times a day untilthe therapeutic effects are no longer needed.

Example 6

[0344] Summary

[0345] Solutions of nanocrystalline noble metal-containing materialswere prepared by immersing Acticoat® burn dressings (distributed bySmith & Nephew) in reverse osmosis water that had been pretreated withCO₂ in order to reduce the pH. Two different concentrations ofantimicrobial metal-containing material with atomic disorder solutionswere prepared by this method, the concentrations being 85 mg/mL and 318mg/mL. Solutions of silver nitrate were also prepared to use ascomparisons in the experiments. The concentrations of the silver nitratewere 103 ppm of silver and 295 ppm of silver as determined by AtomicAbsorption Spectroscopy.

[0346] The solutions were in turn placed in an ultrasonic nebulizer thatcreated small droplets containing dissolved and suspended parts of thesolution of nanocrystalline noble metal-containing material. The outputfrom the nebulizer was directed into a chamber made from a stainlesssteel frame and base. Petri dishes containing Mueller Hinton agarstreaked with 4 h old cultures of Pseudomonas aerugiona andStaphylococcus aureus were exposed to nanocrystalline noble metalaerosols and the silver nitrate aerosols.

[0347] The results of the tests show that nanocrystalline noble metalaerosols transmit the antimicrobial activity of the dressings to remotesites, and nanocrystalline noble metal aerosols are more effective thancomparable concentrations of silver nitrate.

[0348] Introduction

[0349] In many instances the delivery of antimicrobial materials maymost expeditiously be accomplished by using aerosols (e.g., in thetreatment of pneumonia). The drawback of aerosols is the requirement fora high concentration of the active ingredient to ensure that asufficient amount is delivered to achieve the biological effect desiredwithout causing problems with the carrier solvent (e.g., water). Theessential requirement of the equipment for producing an aerosol thatcontains dissolved and suspended components of antimicrobialmetal-containing material with atomic disorder is that it must formdroplets of aerosol directly from the liquid form, and the aerosoldroplets must be small enough to reach the lungs. This means that thedroplets should be preferably less than approximately 10 mm. To meetthese requirements, the aerosol cannot be created by first evaporatingthe liquid and then condensing it to form droplets, since this wouldremove the desired antimicrobial metal-containing material with atomicdisorder from the aerosol. There are two methods that can be used torelatively easily form the droplets directly: (1) mechanical disruptionof the liquid; and (2) air, under pressure, passing through some form oforifice that combines the air and the liquid in a way that createsdroplets instead of evaporating the liquid.

[0350] Several experiments were carried out with antimicrobialmetal-containing material with atomic disorder and silver nitratesolutions to determine if the antimicrobial activity of the dressingcould be transferred through a direct droplet aerosol to a Petri dish.

[0351] Equipment

[0352] The method used to create an aerosol for these tests was themechanical method in the form of an ultrasonic nebulizer. Forconvenience, an ultrasonic humidifier was used. The liquid containingthe dissolved and suspended antimicrobial metal-containing material withatomic disorder was placed in the water reservoir of the humidifier.When power was applied to the humidifier, aerosol droplets of dissolvedand suspended antimicrobial metal-containing material with atomicdisorder were generated and flowed from the output nozzle.

[0353] A test chamber was constructed using a stainless steel frame witha transparent plastic covering. The frame was placed on a stainlesssteel plate. The output nozzle from the humidifier was modified so thatthe aerosol could be directed into the chamber at a height ofapproximately 30 cm from the base. The plates and other test sampleswere placed on the stainless steel plate and exposed to the aerosol fora prescribed length of time.

[0354] Solution 1

[0355] A solution of antimicrobial metal-containing material with atomicdisorder was prepared by immersing 518 sq. inches of Acticoat® burndressing in 1 L of reverse osmosis water, which was treated with CO₂ tomaintain a pH of 6.5. After 20 minutes the concentration of silver inthe water was 85 mg/mL.

[0356] Solution 2

[0357] A solution containing 370 mg/mL of silver from a Acticoat®dressing was prepared as follows: 1 L of reverse osmosis water waspurged with commercial grade carbon dioxide until the pH was 4.3.Sufficient Acticoat® dressing was added to bring the pH up to 6.5. Atthat time, the silver concentration was 370 mg/mL.

[0358] Solution 3

[0359] Ag as AgNO₃ was prepared by dissolving 0.157 g of AgNO₃ into 1 Lof reverse osmosis water and mixed until dissolved. The solution wasanalyzed by Atomic Absorption Spectroscopy and found to be 102.9 ppm ofsilver.

[0360] Solution 4

[0361] Ag as AgNO₃ was prepared by dissolving 0.427 of AgNO₃ into 1 L ofreverse osmosis water and mixed until dissolved. The solution wasanalyzed by Atomic Absorption Spectroscopy and found to be 295 ppm ofsilver.

[0362] Aerosolization

[0363] Petri dishes, containing Mueller Hinton agar, were streaked with4 h old cultures of Pseudomonas aeruginosa or Staphylococcus aureus. Theplates were then weighed and their exposed outer surfaces were coatedwith Parafilm to prevent condensation from occurring on these surfaces.These plates were placed in the aerosol chamber uncovered. Theultrasonic nebulizer was then started and run for 53 minutes. The plateswere then removed from the chamber, the plastic was removed and thedishes re-weighed so that the amount of moisture loss/gain could bedetermined.

[0364] The plates were then placed in a 35° C. incubator for 16 h. Afterincubation the pattern and amount of growth was assessed on the platesfor both organisms.

[0365] Viability Assessment

[0366] Three of the six plates made for each organism were tested todetermine if the antimicrobial effect was cidal or static in nature.This was accomplished by rinsing or placing a piece of the clear sectionof agar in the Petri dish plates into Tryptic soy broth in a test tubeand incubating for 4 h or 16 h. If the medium turned turbid in 4 h itwould indicate that the antimicrobial affect was bacteriostatic innature. If the organism took more than 16 h to grow, as indicated byturbidity, it was considered an indication that both static and cidaleffects occurred. If no growth occurred, the effect was bactericidal.

[0367] Results

[0368] The results for Solutions 1 and 3 are summarized in the followingtwo table. Antimicrobial Metal-Containing Material With Atomic DisorderAgNo₃ Organism Ps. Aeruginosa S. aureus Ps. Aeruginosa S. aureus Agconcen- 85 85 99 99 tration (μg/mL) pH of test 6.5 6.5 Approx. Approx.solution 6.5 6.5 Exposure time 53 53 53 53 (minutes) Exposed area 9.89.8 9.8 9.8 (sq. in) Weight 0.8 0.8 1.05 1.05 gain (g) Growth 0 0 0 ++++at 16 h (0−++++) 0 ++ 0 ++++ at 48 h Viable 4 h No Yes No Yes 16 h YesYes Yes Yes

[0369] The results for Solutions 2 and 4 are summarized in the followingtwo table. Antimicrobial Metal-Containing Material With Atomic DisorderAgNo₃ Organism Ps. aeruginosa S. aureus Ps. aeruginosa S. aureus Agconcen- 370 370 300 300 tration (μg/mL) pH of test 6.5 6.5 Approx.Approx. solution 6.3 6.3 Exposure time 53 53 53 53 (minutes) Exposedarea 9.8 9.8 9.8 9.8 (sq. in) Weight 1.14 1.14 1.12 1.12 gain (g) Growth0 0 0 0 at 16 h (0−++++) 0 0 0 +++ at 48 h Viable 4 h No No No No 16 hNo No No N/A

[0370] Discussion

[0371] At the low concentration of silver in solution, the Acticoat®dressing generated silver was effective at controlling the growth ofboth organisms while the silver nitrate only prevented the growth of Ps.aeruginosa. Viability tests showed that at the low concentration,neither form of silver was completely bactericidal although the poorgrowth on the plates treated with antimicrobial metal-containingmaterial with atomic disorder compared to the silver nitrate treatedplates suggests that a significant log reduction occurred in the platestreated with the aerosol of antimicrobial metal-containing material withatomic disorder.

[0372] At a higher concentration of silver, both antimicrobialmetal-containing material with atomic disorder (370 mg/mL) and AgNO₃(300 mg/mL) were effective at controlling P. aeruginosa. Since nore-growth occurred, it is assumed that the agent at this concentrationwas bactericidal. Antimicrobial silver with atomic disorder was moreeffective than Ag NO₃ at controlling S. aureus. No re-growth occurred onany plates or in the broth indicating a total kill of the organismwhile, in the Ag NO₃ treatment, a large number of organisms grew at 16h.

[0373] Based on weight gain during aerosol treatments, a dose per unitarea can be calculated. In each case for Solution 1, the dose was 8.5mg/sq. inch, while for Solution 2, the dose was 38 mg/sq. inch. Thesedoses, on a per lung basis, would be less than 10 mg of silver per hourof treatment. Each hour of treatment with antimicrobial silver withatomic disorder aerosols appears to provide at least 48 h of protection.Therefore, the dose per day, from the high concentration treatment,would be about 5 mg or a little less than the silver released by 2 sq.inches of SSD per day.

[0374] The most significant advantage of using antimicrobial silver withatomic disorder may be the lack of a toxic action such as NO₃ orsulfadiazine.

[0375] Conclusions

[0376] (1) Aerosols of antimicrobial metal-containing material withatomic disorder transmit the antimicrobial activity of the dressings toremote sites.

[0377] (2) Aerosols of antimicrobial metal-containing material withatomic disorder are more effective than comparable concentrations ofsilver nitrate.

[0378] (3) The dose delivered is acceptable and would not appear to beexcessive.

[0379] (4) No toxic cations (NO₃ or sulfadiazine) are introduced to thepatient.

Example 7 Gels of Antimicrobial Metal-Containing Material With AtomicDisorder

[0380] Gel products of antimicrobial metal-containing material withatomic disorder encompass both wet and dry materials.

[0381] A wet gel product of antimicrobial metal-containing material withatomic disorder is a product that provides moisture to a dry skincondition (psoriasis, eczema, acne, wound, etc.) and facilitatesautolytic debridement of necrotic tissue. It also delivers theantimicrobial and anti-inflammatory properties of the suspendedantimicrobial metal-containing material with atomic disorder powders.

[0382] In many instances it is also beneficial to supply biologicallyactive molecules to elicit a specific response such as cell migration,etc. Since these biologically active molecules are susceptible tomicrobial degradation if not protected, it is beneficial to include themin gels of antimicrobial metal-containing material with atomic disorderthat will provide the necessary protection.

[0383] Dry gel products of antimicrobial metal-containing material withatomic disorder are physically stabilized (dry or cross-linked)materials that provide lubricious, antimicrobial, antithrombogenic, andanti-inflammatory properties to a variety of implantable, trancutaneousor topically applied devices. The coatings may also provide otherbenefits such as accelerating or otherwise facilitating tissueintegration by creating a favorable environment for cell proliferation.This favorable environment may be created by including cyto-conductiveagents or anti-adhesion agents such as bone morphogenetic proteins,B-glucan hyaluronic acids in the gel. The gel may be stabilized bycross-linking the gel components (collagen, gelatin, etc.) or by dryingthe coated materials.

[0384] Examples of the primary gelling agents are listed in thefollowing table. Biologically active ingredients that may be used, inany combination with the primary gelling agents, are given in thesubsequent table. Materials that should not be used with gels ofantimicrobial silver with atomic disorder are given in the final table.Material Percentage Composition Carboxymethyl cellulose (CMC) 0.1-10Polyvinyl alcohol (PVA) 0.1-10 Collagen 0.1-10 Pectin 0.1-10 Gelatin0.1-10 Chitin 0.1-10 Chitosan 0.1-10 Alginate 0.1-10 Poly (α-aminoacids) Polyester Poly-1-caprolactone PEG Cocoa butter SepigelBiologically Active Ingredients Methyl paraben <3 Propyl paraben <3B-glucan <5 Hyaluronic acid <5 Epidermal growth factor <1 Plateletderived growth factor <1 Transforming growth factor <1 Vascularendothelial growth factor <1 Interleukins <1 Heparin <5 Bonemorphogenetic proteins <1 Non-Compatible Materials Chloride salts >0.01Aldehydes >0.01 Ketones >0.01 Long chain alcohols >0.01 Glycerol >0.01Triethanolamine >0.01

Example 8 Examples of Gels with Antimicrobial Metal-Containing MaterialWith Atomic Disorder

[0385] Gels were prepared as described above in Example 11 in theTreatment of Inflammatory Skin Conditions examples above.

[0386] Other embodiments are in the claims.

What is claimed is:
 1. A method for the treatment or prophylaxis of anungual or subungual disease of a subject, the method comprising: using aneedleless injector to deliver a compound to an area of the subjectassociated with the disease, the compound being effective in thetreatment of the disease.
 2. The method of claim 1, wherein the compoundcomprises a metal-containing material.
 3. The method of claim 1, whereinthe compound comprises an anti-fungal compound.
 4. The method of claim1, wherein the compound is selected from the group consisting ofgriseofulvin, terbinafine, citopirox, itraconazole, ketoconazole andcombinations thereof.
 5. The method of claim 4, wherein the disease isselected from the group consisting of onychomycosis, tinea unguiminfection, and combinations thereof.
 6. The method of claim 1, whereinthe disease is selected from the group consisting of onychomycosis,tinea unguim infection, psoriasis of the unguis, eczema of the unguis,lichen planus of the unguis, viral warts of the unguis and combinationsthereof.
 7. The method of claim 1, wherein the disease is a subungualdisease.
 8. The method of claim 1, wherein the disease is an ungualdisease.
 9. The method of claim 1, wherein the area of the subjectcomprises an unguis.
 10. The method of claim 9, wherein the subject is ahuman and the unguis is a toe nail.
 11. The method of claim 9, whereinthe subject is a human and the unguis is a finger nail.
 12. The methodof claim 1, wherein the area of the subject comprises tissue adjacent anunguis of the subject.
 13. The method of claim 12, wherein the tissueadjacent the unguis of the subject comprises skin.
 14. The method ofclaim 1, wherein the needleless injector delivers the compound into anunguis of the subject.
 15. The method of claim 14, wherein theneedleless injector delivers the compound through the unguis of thesubject.
 16. The method of claim 1, wherein the needleless injectordelivers the compound through an unguis of the subject.
 17. The methodof claim 1, wherein the needleless injector delivers the compound intotissue adjacent an unguis of the subject.
 18. The method of claim 17,wherein the tissue adjacent the unguis of the subject comprises skin.19. The method of claim 17, wherein the needleless injector delivers thecompound through the tissue adjacent the unguis.
 20. The method of claim1, wherein the needleless injector delivers the compound through tissueadjacent an unguis of the subject.
 21. The method of claim 20, whereinthe tissue adjacent the unguis of the subject comprises skin.
 22. Themethod of claim 1, wherein the needleless injector delivers the compoundinto an unguis of the subject and into tissue adjacent the unguis of thesubject.
 23. The method of claim 22, wherein the needleless injectordelivers the compound through the unguis of the subject.
 24. The methodof claim 23, wherein the needleless injector delivers the compoundthrough tissue adjacent an unguis of the subject.
 25. The method ofclaim 22, wherein the needleless injector delivers the compound throughtissue adjacent an unguis of the subject.
 26. The method of claim 1,wherein the subject is a human.
 27. A method for the treatment orprophylaxis of an ungual or subungual disease of a subject, the methodcomprising: using iontophoresis to deliver a compound to an area of thesubject associated with the disease, the compound being effective in thetreatment of the disease.
 28. The method of claim 27, wherein thecompound comprises a metal-containing material.
 29. The method of claim27, wherein the compound comprises an anti-fungal compound.
 30. Themethod of claim 27, wherein the compound is selected from the groupconsisting of griseofulvin, terbinafine, citopirox, itraconazole,ketoconazole and combinations thereof.
 31. The method of claim 30,wherein the disease is selected from the group consisting ofonychomycosis, tinea unguim infection, and combinations thereof.
 32. Themethod of claim 27, wherein the disease is selected from the groupconsisting of onychomycosis, tinea unguim infection, psoriasis of theunguis, eczema of the unguis, lichen planus of the unguis, viral wartsof the unguis and combinations thereof.
 33. The method of claim 27,wherein the disease is a subungual disease.
 34. The method of claim 27,wherein the disease is an ungual disease.
 35. The method of claim 27,wherein the area of the subject comprises an unguis.
 36. The method ofclaim 35, wherein the subject is a human and the unguis is a toe nail.37. The method of claim 35, wherein the subject is a human and theunguis is a finger nail.
 38. The method of claim 27, wherein the area ofthe subject comprises tissue adjacent an unguis of the subject.
 39. Themethod of claim 38, wherein the tissue adjacent the unguis of thesubject comprises skin.
 40. The method of claim 27, whereiniontophoresis delivers the compound into an unguis of the subject. 41.The method of claim 40, wherein iontophoresis delivers the compoundthrough the unguis of the subject.
 42. The method of claim 27, whereiniontophoresis delivers the compound through an unguis of the subject.43. The method of claim 27, wherein iontophoresis the compound intotissue adjacent an unguis of the subject.
 44. The method of claim 43,wherein the tissue adjacent the unguis of the subject comprises skin.45. The method of claim 43, wherein iontophoresis delivers the compoundthrough the tissue adjacent the unguis.
 46. The method of claim 27,wherein iontophoresis the compound through tissue adjacent an unguis ofthe subject.
 47. The method of claim 46, wherein the tissue adjacent theunguis of the subject comprises skin.
 48. The method of claim 27,wherein iontophoresis delivers the compound into an unguis of thesubject and into tissue adjacent the unguis of the subject.
 49. Themethod of claim 48, wherein iontophoresis delivers the compound throughthe unguis of the subject.
 50. The method of claim 49, whereiniontophoresis delivers the compound through tissue adjacent an unguis ofthe subject.
 51. The method of claim 48, wherein iontophoresis deliversthe compound through tissue adjacent an unguis of the subject.
 52. Themethod of claim 27, wherein the subject is a human.